Rep. Kelly M. Cassidy
Filed: 5/19/2023
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1 | AMENDMENT TO SENATE BILL 1561
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2 | AMENDMENT NO. ______. Amend Senate Bill 1561 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. "An Act concerning regulation", approved | ||||||
5 | January 13, 2023, Public Act 102-1117, is amended by changing | ||||||
6 | Section 99-99 as follows: | ||||||
7 | (P.A. 102-1117, Sec. 99-99)
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8 | Sec. 99-99. Effective date. This Act takes effect upon | ||||||
9 | becoming law , except that Article 16 takes effect on January | ||||||
10 | 1, 2025 .
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11 | (Source: P.A. 102-1117, eff. 1-13-23.) | ||||||
12 | Section 10. The State Employees Group Insurance Act of | ||||||
13 | 1971 is amended by changing Section 6.11 as follows:
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14 | (5 ILCS 375/6.11)
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1 | (Text of Section before amendment by P.A. 102-768 ) | ||||||
2 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
3 | Code
requirements. The program of health
benefits shall | ||||||
4 | provide the post-mastectomy care benefits required to be | ||||||
5 | covered
by a policy of accident and health insurance under | ||||||
6 | Section 356t of the Illinois
Insurance Code. The program of | ||||||
7 | health benefits shall provide the coverage
required under | ||||||
8 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | ||||||
9 | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
10 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||||
11 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
12 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
13 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 , and | ||||||
14 | 356z.62 of the
Illinois Insurance Code.
The program of health | ||||||
15 | benefits must comply with Sections 155.22a, 155.37, 355b, | ||||||
16 | 356z.19, 370c, and 370c.1 and Article XXXIIB of the
Illinois | ||||||
17 | Insurance Code. The Department of Insurance shall enforce the | ||||||
18 | requirements of this Section with respect to Sections 370c and | ||||||
19 | 370c.1 of the Illinois Insurance Code; all other requirements | ||||||
20 | of this Section shall be enforced by the Department of Central | ||||||
21 | Management Services.
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22 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
23 | any, is conditioned on the rules being adopted in accordance | ||||||
24 | with all provisions of the Illinois Administrative Procedure | ||||||
25 | Act and all rules and procedures of the Joint Committee on | ||||||
26 | Administrative Rules; any purported rule not so adopted, for |
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1 | whatever reason, is unauthorized. | ||||||
2 | (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | ||||||
3 | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||||||
4 | 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | ||||||
5 | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||||||
6 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||||||
7 | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | ||||||
8 | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
9 | revised 12-13-22.) | ||||||
10 | (Text of Section after amendment by P.A. 102-768 ) | ||||||
11 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
12 | Code
requirements. The program of health
benefits shall | ||||||
13 | provide the post-mastectomy care benefits required to be | ||||||
14 | covered
by a policy of accident and health insurance under | ||||||
15 | Section 356t of the Illinois
Insurance Code. The program of | ||||||
16 | health benefits shall provide the coverage
required under | ||||||
17 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | ||||||
18 | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
19 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||||
20 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
21 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
22 | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and | ||||||
23 | 356z.60 , and 356z.62 of the
Illinois Insurance Code.
The | ||||||
24 | program of health benefits must comply with Sections 155.22a, | ||||||
25 | 155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of |
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1 | the
Illinois Insurance Code. The Department of Insurance shall | ||||||
2 | enforce the requirements of this Section with respect to | ||||||
3 | Sections 370c and 370c.1 of the Illinois Insurance Code; all | ||||||
4 | other requirements of this Section shall be enforced by the | ||||||
5 | Department of Central Management Services.
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6 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
7 | any, is conditioned on the rules being adopted in accordance | ||||||
8 | with all provisions of the Illinois Administrative Procedure | ||||||
9 | Act and all rules and procedures of the Joint Committee on | ||||||
10 | Administrative Rules; any purported rule not so adopted, for | ||||||
11 | whatever reason, is unauthorized. | ||||||
12 | (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | ||||||
13 | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||||||
14 | 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | ||||||
15 | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||||||
16 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||||||
17 | 1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, | ||||||
18 | eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; | ||||||
19 | 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | ||||||
20 | Section 15. The Criminal Identification Act is amended by | ||||||
21 | changing Section 3.2 as follows:
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22 | (20 ILCS 2630/3.2) (from Ch. 38, par. 206-3.2)
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23 | Sec. 3.2.
(a) It is the duty of any person conducting or | ||||||
24 | operating a medical facility,
or any physician or nurse as |
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1 | soon as treatment permits to notify the local
law enforcement | ||||||
2 | agency of that jurisdiction upon the application for
treatment | ||||||
3 | of a person who is not accompanied by a law enforcement | ||||||
4 | officer,
when it reasonably appears that the person requesting | ||||||
5 | treatment has
received:
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6 | (1) any injury resulting from the discharge of a | ||||||
7 | firearm; or
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8 | (2) any injury sustained in the commission of or as a | ||||||
9 | victim of a
criminal offense.
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10 | Any hospital, physician or nurse shall be forever held | ||||||
11 | harmless from
any civil liability for their reasonable | ||||||
12 | compliance with the provisions of
this Section. | ||||||
13 | (b) Notwithstanding subsection (a), nothing in this
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14 | Section shall be construed to require the reporting of lawful
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15 | health care activity, whether such activity may constitute a
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16 | violation of another state's law. | ||||||
17 | (c) As used in this Section: | ||||||
18 | "Lawful health care" means: | ||||||
19 | (1) reproductive health care that is not unlawful | ||||||
20 | under the laws of this State or was not unlawful under the | ||||||
21 | laws of this State as of January 13, 2023 (the effective | ||||||
22 | date of Public Act 102-1117) , including on any theory of | ||||||
23 | vicarious, joint, several, or conspiracy liability; or | ||||||
24 | (2) the treatment of gender dysphoria or the | ||||||
25 | affirmation of an individual's gender identity or gender | ||||||
26 | expression, including but not limited to, all supplies, |
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1 | care, and services of a medical, behavioral health, mental | ||||||
2 | health, surgical, psychiatric, therapeutic, diagnostic, | ||||||
3 | preventative, rehabilitative, or supportive nature that is | ||||||
4 | not unlawful under the laws of this State or was not | ||||||
5 | unlawful under the laws of this State as of January 13, | ||||||
6 | 2023 (the effective date of Public Act 102-1117) , | ||||||
7 | including on any theory of vicarious, joint, several, or | ||||||
8 | conspiracy liability.
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9 | "Lawful health care activity" means seeking, providing,
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10 | receiving, assisting in seeking, providing, or receiving,
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11 | providing material support for, or traveling to obtain lawful
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12 | health care. | ||||||
13 | (Source: P.A. 102-1117, eff. 1-13-23.)
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14 | Section 20. The Counties Code is amended by changing | ||||||
15 | Section 5-1069.3 as follows: | ||||||
16 | (55 ILCS 5/5-1069.3)
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17 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
18 | including a home
rule
county, is a self-insurer for purposes | ||||||
19 | of providing health insurance coverage
for its employees, the | ||||||
20 | coverage shall include coverage for the post-mastectomy
care | ||||||
21 | benefits required to be covered by a policy of accident and | ||||||
22 | health
insurance under Section 356t and the coverage required | ||||||
23 | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u,
356w, 356x, | ||||||
24 | 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, |
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1 | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | ||||||
2 | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | ||||||
3 | 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, | ||||||
4 | 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 , and 356z.62 | ||||||
5 | of
the Illinois Insurance Code. The coverage shall comply with | ||||||
6 | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | ||||||
7 | Insurance Code. The Department of Insurance shall enforce the | ||||||
8 | requirements of this Section. The requirement that health | ||||||
9 | benefits be covered
as provided in this Section is an
| ||||||
10 | exclusive power and function of the State and is a denial and | ||||||
11 | limitation under
Article VII, Section 6, subsection (h) of the | ||||||
12 | Illinois Constitution. A home
rule county to which this | ||||||
13 | Section applies must comply with every provision of
this | ||||||
14 | Section.
| ||||||
15 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
16 | any, is conditioned on the rules being adopted in accordance | ||||||
17 | with all provisions of the Illinois Administrative Procedure | ||||||
18 | Act and all rules and procedures of the Joint Committee on | ||||||
19 | Administrative Rules; any purported rule not so adopted, for | ||||||
20 | whatever reason, is unauthorized. | ||||||
21 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
22 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
23 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
24 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | ||||||
25 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||||||
26 | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, |
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| |||||||
1 | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
2 | 102-1117, eff. 1-13-23.) | ||||||
3 | Section 25. The Illinois Municipal Code is amended by | ||||||
4 | changing Section 10-4-2.3 as follows: | ||||||
5 | (65 ILCS 5/10-4-2.3)
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6 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
7 | municipality, including a
home rule municipality, is a | ||||||
8 | self-insurer for purposes of providing health
insurance | ||||||
9 | coverage for its employees, the coverage shall include | ||||||
10 | coverage for
the post-mastectomy care benefits required to be | ||||||
11 | covered by a policy of
accident and health insurance under | ||||||
12 | Section 356t and the coverage required
under Sections 356g, | ||||||
13 | 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | ||||||
14 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
15 | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
16 | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||||||
17 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||||||
18 | 356z.56, 356z.57, 356z.59, and 356z.60 , and 356z.62 of the | ||||||
19 | Illinois
Insurance
Code. The coverage shall comply with | ||||||
20 | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | ||||||
21 | Insurance Code. The Department of Insurance shall enforce the | ||||||
22 | requirements of this Section. The requirement that health
| ||||||
23 | benefits be covered as provided in this is an exclusive power | ||||||
24 | and function of
the State and is a denial and limitation under |
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| |||||||
1 | Article VII, Section 6,
subsection (h) of the Illinois | ||||||
2 | Constitution. A home rule municipality to which
this Section | ||||||
3 | applies must comply with every provision of this Section.
| ||||||
4 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
5 | any, is conditioned on the rules being adopted in accordance | ||||||
6 | with all provisions of the Illinois Administrative Procedure | ||||||
7 | Act and all rules and procedures of the Joint Committee on | ||||||
8 | Administrative Rules; any purported rule not so adopted, for | ||||||
9 | whatever reason, is unauthorized. | ||||||
10 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
11 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
12 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
13 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | ||||||
14 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||||||
15 | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | ||||||
16 | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
17 | 102-1117, eff. 1-13-23.) | ||||||
18 | Section 30. The School Code is amended by changing Section | ||||||
19 | 10-22.3f as follows: | ||||||
20 | (105 ILCS 5/10-22.3f)
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21 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
22 | protection and
benefits
for employees shall provide the | ||||||
23 | post-mastectomy care benefits required to be
covered by a | ||||||
24 | policy of accident and health insurance under Section 356t and |
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| |||||||
1 | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
2 | 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, | ||||||
3 | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | ||||||
4 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
5 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
6 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 , and | ||||||
7 | 356z.62 of
the
Illinois Insurance Code.
Insurance policies | ||||||
8 | shall comply with Section 356z.19 of the Illinois Insurance | ||||||
9 | Code. The coverage shall comply with Sections 155.22a, 355b, | ||||||
10 | and 370c of
the Illinois Insurance Code. The Department of | ||||||
11 | Insurance shall enforce the requirements of this Section.
| ||||||
12 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
13 | any, is conditioned on the rules being adopted in accordance | ||||||
14 | with all provisions of the Illinois Administrative Procedure | ||||||
15 | Act and all rules and procedures of the Joint Committee on | ||||||
16 | Administrative Rules; any purported rule not so adopted, for | ||||||
17 | whatever reason, is unauthorized. | ||||||
18 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
19 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
20 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
21 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; | ||||||
22 | 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff. | ||||||
23 | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, | ||||||
24 | eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | ||||||
25 | Section 35. The Illinois Insurance Code is amended by |
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1 | changing Section 356z.4 and by adding Section 356z.62 as | ||||||
2 | follows:
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3 | (215 ILCS 5/356z.4)
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4 | Sec. 356z.4. Coverage for contraceptives. | ||||||
5 | (a)(1) The General Assembly hereby finds and declares all | ||||||
6 | of the following: | ||||||
7 | (A) Illinois has a long history of expanding timely | ||||||
8 | access to birth control to prevent unintended pregnancy. | ||||||
9 | (B) The federal Patient Protection and Affordable Care | ||||||
10 | Act includes a contraceptive coverage guarantee as part of | ||||||
11 | a broader requirement for health insurance to cover key | ||||||
12 | preventive care services without out-of-pocket costs for | ||||||
13 | patients. | ||||||
14 | (C) The General Assembly intends to build on existing | ||||||
15 | State and federal law to promote gender equity and women's | ||||||
16 | health and to ensure greater contraceptive coverage equity | ||||||
17 | and timely access to all federal Food and Drug | ||||||
18 | Administration approved methods of birth control for all | ||||||
19 | individuals covered by an individual or group health | ||||||
20 | insurance policy in Illinois. | ||||||
21 | (D) Medical management techniques such as denials, | ||||||
22 | step therapy, or prior authorization in public and private | ||||||
23 | health care coverage can impede access to the most | ||||||
24 | effective contraceptive methods. | ||||||
25 | (2) As used in this subsection (a): |
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1 | "Contraceptive services" includes consultations, | ||||||
2 | examinations, procedures, and medical services related to the | ||||||
3 | use of contraceptive methods (including natural family | ||||||
4 | planning) to prevent an unintended pregnancy. | ||||||
5 | "Medical necessity", for the purposes of this subsection | ||||||
6 | (a), includes, but is not limited to, considerations such as | ||||||
7 | severity of side effects, differences in permanence and | ||||||
8 | reversibility of contraceptive, and ability to adhere to the | ||||||
9 | appropriate use of the item or service, as determined by the | ||||||
10 | attending provider. | ||||||
11 | "Therapeutic equivalent version" means drugs, devices, or | ||||||
12 | products that can be expected to have the same clinical effect | ||||||
13 | and safety profile when administered to patients under the | ||||||
14 | conditions specified in the labeling and satisfy the following | ||||||
15 | general criteria: | ||||||
16 | (i) they are approved as safe and effective; | ||||||
17 | (ii) they are pharmaceutical equivalents in that they | ||||||
18 | (A) contain identical amounts of the same active drug | ||||||
19 | ingredient in the same dosage form and route of | ||||||
20 | administration and (B) meet compendial or other applicable | ||||||
21 | standards of strength, quality, purity, and identity; | ||||||
22 | (iii) they are bioequivalent in that (A) they do not | ||||||
23 | present a known or potential bioequivalence problem and | ||||||
24 | they meet an acceptable in vitro standard or (B) if they do | ||||||
25 | present such a known or potential problem, they are shown | ||||||
26 | to meet an appropriate bioequivalence standard; |
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| |||||||
1 | (iv) they are adequately labeled; and | ||||||
2 | (v) they are manufactured in compliance with Current | ||||||
3 | Good Manufacturing Practice regulations. | ||||||
4 | (3) An individual or group policy of accident and health | ||||||
5 | insurance amended,
delivered, issued, or renewed in this State | ||||||
6 | after the effective date of this amendatory Act of the 99th | ||||||
7 | General Assembly shall provide coverage for all of the | ||||||
8 | following services and contraceptive methods: | ||||||
9 | (A) All contraceptive drugs, devices, and other | ||||||
10 | products approved by the United States Food and Drug | ||||||
11 | Administration. This includes all over-the-counter | ||||||
12 | contraceptive drugs, devices, and products approved by the | ||||||
13 | United States Food and Drug Administration, excluding male | ||||||
14 | condoms , except as provided in the current comprehensive | ||||||
15 | guidelines supported by the Health Resources and Services | ||||||
16 | Administration . The following apply: | ||||||
17 | (i) If the United States Food and Drug | ||||||
18 | Administration has approved one or more therapeutic | ||||||
19 | equivalent versions of a contraceptive drug, device, | ||||||
20 | or product, a policy is not required to include all | ||||||
21 | such therapeutic equivalent versions in its formulary, | ||||||
22 | so long as at least one is included and covered without | ||||||
23 | cost-sharing and in accordance with this Section. | ||||||
24 | (ii) If an individual's attending provider | ||||||
25 | recommends a particular service or item approved by | ||||||
26 | the United States Food and Drug Administration based |
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1 | on a determination of medical necessity with respect | ||||||
2 | to that individual, the plan or issuer must cover that | ||||||
3 | service or item without cost sharing. The plan or | ||||||
4 | issuer must defer to the determination of the | ||||||
5 | attending provider. | ||||||
6 | (iii) If a drug, device, or product is not | ||||||
7 | covered, plans and issuers must have an easily | ||||||
8 | accessible, transparent, and sufficiently expedient | ||||||
9 | process that is not unduly burdensome on the | ||||||
10 | individual or a provider or other individual acting as | ||||||
11 | a patient's authorized representative to ensure | ||||||
12 | coverage without cost sharing. | ||||||
13 | (iv) This coverage must provide for the dispensing | ||||||
14 | of 12 months' worth of contraception at one time. | ||||||
15 | (B) Voluntary sterilization procedures. | ||||||
16 | (C) Contraceptive services, patient education, and | ||||||
17 | counseling on contraception. | ||||||
18 | (D) Follow-up services related to the drugs, devices, | ||||||
19 | products, and procedures covered under this Section, | ||||||
20 | including, but not limited to, management of side effects, | ||||||
21 | counseling for continued adherence, and device insertion | ||||||
22 | and removal. | ||||||
23 | (4) Except as otherwise provided in this subsection (a), a | ||||||
24 | policy subject to this subsection (a) shall not impose a | ||||||
25 | deductible, coinsurance, copayment, or any other cost-sharing | ||||||
26 | requirement on the coverage provided. The provisions of this |
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| |||||||
1 | paragraph do not apply to coverage of voluntary male | ||||||
2 | sterilization procedures to the extent such coverage would | ||||||
3 | disqualify a high-deductible health plan from eligibility for | ||||||
4 | a health savings account pursuant to the federal Internal | ||||||
5 | Revenue Code, 26 U.S.C. 223. | ||||||
6 | (5) Except as otherwise authorized under this subsection | ||||||
7 | (a), a policy shall not impose any restrictions or delays on | ||||||
8 | the coverage required under this subsection (a). | ||||||
9 | (6) If, at any time, the Secretary of the United States | ||||||
10 | Department of Health and Human Services, or its successor | ||||||
11 | agency, promulgates rules or regulations to be published in | ||||||
12 | the Federal Register or publishes a comment in the Federal | ||||||
13 | Register or issues an opinion, guidance, or other action that | ||||||
14 | would require the State, pursuant to any provision of the | ||||||
15 | Patient Protection and Affordable Care Act (Public Law | ||||||
16 | 111-148), including, but not limited to, 42 U.S.C. | ||||||
17 | 18031(d)(3)(B) or any successor provision, to defray the cost | ||||||
18 | of any coverage outlined in this subsection (a), then this | ||||||
19 | subsection (a) is inoperative with respect to all coverage | ||||||
20 | outlined in this subsection (a) other than that authorized | ||||||
21 | under Section 1902 of the Social Security Act, 42 U.S.C. | ||||||
22 | 1396a, and the State shall not assume any obligation for the | ||||||
23 | cost of the coverage set forth in this subsection (a). | ||||||
24 | (b) This subsection (b) shall become operative if and only | ||||||
25 | if subsection (a) becomes inoperative. | ||||||
26 | An individual or group policy of accident and health |
| |||||||
| |||||||
1 | insurance amended,
delivered, issued, or renewed in this State | ||||||
2 | after the date this subsection (b) becomes operative that | ||||||
3 | provides coverage for
outpatient services and outpatient | ||||||
4 | prescription drugs or devices must provide
coverage for the | ||||||
5 | insured and any
dependent of the
insured covered by the policy | ||||||
6 | for all outpatient contraceptive services and
all outpatient | ||||||
7 | contraceptive drugs and devices approved by the Food and
Drug | ||||||
8 | Administration. Coverage required under this Section may not | ||||||
9 | impose any
deductible, coinsurance, waiting period, or other | ||||||
10 | cost-sharing or limitation
that is greater than that required | ||||||
11 | for any outpatient service or outpatient
prescription drug or | ||||||
12 | device otherwise covered by the policy.
| ||||||
13 | Nothing in this subsection (b) shall be construed to | ||||||
14 | require an insurance
company to cover services related to | ||||||
15 | permanent sterilization that requires a
surgical procedure. | ||||||
16 | As used in this subsection (b), "outpatient contraceptive | ||||||
17 | service" means
consultations, examinations, procedures, and | ||||||
18 | medical services, provided on an
outpatient basis and related | ||||||
19 | to the use of contraceptive methods (including
natural family | ||||||
20 | planning) to prevent an unintended pregnancy.
| ||||||
21 | (c) (Blank).
| ||||||
22 | (d) If a plan or issuer utilizes a network of providers, | ||||||
23 | nothing in this Section shall be construed to require coverage | ||||||
24 | or to prohibit the plan or issuer from imposing cost-sharing | ||||||
25 | for items or services described in this Section that are | ||||||
26 | provided or delivered by an out-of-network provider, unless |
| |||||||
| |||||||
1 | the plan or issuer does not have in its network a provider who | ||||||
2 | is able to or is willing to provide the applicable items or | ||||||
3 | services.
| ||||||
4 | (Source: P.A. 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19.)
| ||||||
5 | (215 ILCS 5/356z.62 new) | ||||||
6 | Sec. 356z.62. Coverage of preventive health services. | ||||||
7 | (a) A policy of group health insurance coverage or | ||||||
8 | individual health insurance coverage as defined in Section 5 | ||||||
9 | of the Illinois Health Insurance Portability and | ||||||
10 | Accountability Act shall, at a minimum, provide coverage for | ||||||
11 | and shall not impose any cost-sharing requirements, including | ||||||
12 | a copayment, coinsurance, or deductible, for: | ||||||
13 | (1) evidence-based items or services that have in | ||||||
14 | effect a rating of "A" or "B" in the current | ||||||
15 | recommendations of the United States Preventive Services | ||||||
16 | Task Force; | ||||||
17 | (2) immunizations that have in effect a recommendation | ||||||
18 | from the Advisory Committee on Immunization Practices of | ||||||
19 | the Centers for Disease Control and Prevention with | ||||||
20 | respect to the individual involved; | ||||||
21 | (3) with respect to infants, children, and | ||||||
22 | adolescents, evidence-informed preventive care and | ||||||
23 | screenings provided for in the comprehensive guidelines | ||||||
24 | supported by the Health Resources and Services | ||||||
25 | Administration; and |
| |||||||
| |||||||
1 | (4) with respect to women, such additional preventive | ||||||
2 | care and screenings not described in paragraph (1) of this | ||||||
3 | subsection (a) as provided for in comprehensive guidelines | ||||||
4 | supported by the Health Resources and Services | ||||||
5 | Administration for purposes of this paragraph. | ||||||
6 | (b) For purposes of this Section, and for purposes of any | ||||||
7 | other provision of State law, recommendations of the United | ||||||
8 | States Preventive Services Task Force regarding breast cancer | ||||||
9 | screening, mammography, and prevention issued in or around | ||||||
10 | November 2009 are not considered to be current. | ||||||
11 | (c) For office visits: | ||||||
12 | (1) if an item or service described in subsection (a) | ||||||
13 | is billed separately or is tracked as individual encounter | ||||||
14 | data separately from an office visit, then a policy may | ||||||
15 | impose cost-sharing requirements with respect to the | ||||||
16 | office visit; | ||||||
17 | (2) if an item or service described in subsection (a) | ||||||
18 | is not billed separately or is not tracked as individual | ||||||
19 | encounter data separately from an office visit and the | ||||||
20 | primary purpose of the office visit is the delivery of | ||||||
21 | such an item or service, then a policy may not impose | ||||||
22 | cost-sharing requirements with respect to the office | ||||||
23 | visit; and | ||||||
24 | (3) if an item or service described in subsection (a) | ||||||
25 | is not billed separately or is not tracked as individual | ||||||
26 | encounter data separately from an office visit and the |
| |||||||
| |||||||
1 | primary purpose of the office visit is not the delivery of | ||||||
2 | such an item or service, then a policy may impose | ||||||
3 | cost-sharing requirements with respect to the office | ||||||
4 | visit. | ||||||
5 | (d) A policy must provide coverage pursuant to subsection | ||||||
6 | (a) for plan or policy years that begin on or after the date | ||||||
7 | that is one year after the date the recommendation or | ||||||
8 | guideline is issued. If a recommendation or guideline is in | ||||||
9 | effect on the first day of the plan or policy year, the policy | ||||||
10 | shall cover the items and services specified in the | ||||||
11 | recommendation or guideline through the last day of the plan | ||||||
12 | or policy year unless either: | ||||||
13 | (1) a recommendation under paragraph (1) of subsection | ||||||
14 | (a) is downgraded to a "D" rating; or | ||||||
15 | (2) the item or service is subject to a safety recall | ||||||
16 | or is otherwise determined to pose a significant safety | ||||||
17 | concern by a federal agency authorized to regulate the | ||||||
18 | item or service during the plan or policy year. | ||||||
19 | (e) Network limitations. | ||||||
20 | (1) Subject to paragraph (3) of this subsection, | ||||||
21 | nothing in this Section requires coverage for items or | ||||||
22 | services described in subsection (a) that are delivered by | ||||||
23 | an out-of-network provider under a health maintenance | ||||||
24 | organization health care plan, other than a | ||||||
25 | point-of-service contract, or under a voluntary health | ||||||
26 | services plan that generally excludes coverage for |
| |||||||
| |||||||
1 | out-of-network services except as otherwise required by | ||||||
2 | law. | ||||||
3 | (2) Subject to paragraph (3) of this subsection, | ||||||
4 | nothing in this Section precludes a policy with a | ||||||
5 | preferred provider program under Article XX-1/2 of this | ||||||
6 | Code, a health maintenance organization point-of-service | ||||||
7 | contract, or a similarly designed voluntary health | ||||||
8 | services plan from imposing cost-sharing requirements for | ||||||
9 | items or services described in subsection (a) that are | ||||||
10 | delivered by an out-of-network provider. | ||||||
11 | (3) If a policy does not have in its network a provider | ||||||
12 | who can provide an item or service described in subsection | ||||||
13 | (a), then the policy must cover the item or service when | ||||||
14 | performed by an out-of-network provider and it may not | ||||||
15 | impose cost-sharing with respect to the item or service. | ||||||
16 | (f) Nothing in this Section prevents a company from using | ||||||
17 | reasonable medical management techniques to determine the | ||||||
18 | frequency, method, treatment, or setting for an item or | ||||||
19 | service described in subsection (a) to the extent not | ||||||
20 | specified in the recommendation or guideline. | ||||||
21 | (g) Nothing in this Section shall be construed to prohibit | ||||||
22 | a policy from providing coverage for items or services in | ||||||
23 | addition to those required under subsection (a) or from | ||||||
24 | denying coverage for items or services that are not required | ||||||
25 | under subsection (a). Unless prohibited by other law, a policy | ||||||
26 | may impose cost-sharing requirements for a treatment not |
| |||||||
| |||||||
1 | described in subsection (a) even if the treatment results from | ||||||
2 | an item or service described in subsection (a). Nothing in | ||||||
3 | this Section shall be construed to limit coverage requirements | ||||||
4 | provided under other law. | ||||||
5 | (h) The Director may develop guidelines to permit a | ||||||
6 | company to utilize value-based insurance designs. In the | ||||||
7 | absence of guidelines developed by the Director, any such | ||||||
8 | guidelines developed by the Secretary of the U.S. Department | ||||||
9 | of Health and Human Services that are in force under 42 U.S.C. | ||||||
10 | 300gg-13 shall apply. | ||||||
11 | (i) For student health insurance coverage as defined at 45 | ||||||
12 | CFR 147.145, student administrative health fees are not | ||||||
13 | considered cost-sharing requirements with respect to | ||||||
14 | preventive services specified under subsection (a). As used in | ||||||
15 | this subsection, "student administrative health fee" means a | ||||||
16 | fee charged by an institution of higher education on a | ||||||
17 | periodic basis to its students to offset the cost of providing | ||||||
18 | health care through health clinics regardless of whether the | ||||||
19 | students utilize the health clinics or enroll in student | ||||||
20 | health insurance coverage. | ||||||
21 | (j) For any recommendation or guideline specifically | ||||||
22 | referring to women or men, a company shall not deny or limit | ||||||
23 | the coverage required or a claim made under subsection (a) | ||||||
24 | based solely on the individual's recorded sex or actual or | ||||||
25 | perceived gender identity, or for the reason that the | ||||||
26 | individual is gender nonconforming, intersex, transgender, or |
| |||||||
| |||||||
1 | has undergone, or is in the process of undergoing, gender | ||||||
2 | transition, if, notwithstanding the sex or gender assigned at | ||||||
3 | birth, the covered individual meets the conditions for the | ||||||
4 | recommendation or guideline at the time the item or service is | ||||||
5 | furnished. | ||||||
6 | (k) This Section does not apply to grandfathered health | ||||||
7 | plans, excepted benefits, or short-term, limited-duration | ||||||
8 | health insurance coverage. | ||||||
9 | Section 40. The Health Maintenance Organization Act is | ||||||
10 | amended by changing Section 5-3 as follows:
| ||||||
11 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| ||||||
12 | Sec. 5-3. Insurance Code provisions.
| ||||||
13 | (a) Health Maintenance Organizations
shall be subject to | ||||||
14 | the provisions of Sections 133, 134, 136, 137, 139, 140, | ||||||
15 | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | ||||||
16 | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | ||||||
17 | 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, | ||||||
18 | 356y,
356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | ||||||
19 | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | ||||||
20 | 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | ||||||
21 | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | ||||||
22 | 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48, | ||||||
23 | 356z.50, 356z.51, 356z.53 256z.53 , 356z.54, 356z.56, 356z.57, | ||||||
24 | 356z.59, 356z.60, 356z.62, 364, 364.01, 364.3, 367.2, 367.2-5, |
| |||||||
| |||||||
1 | 367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, | ||||||
2 | 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
| ||||||
3 | paragraph (c) of subsection (2) of Section 367, and Articles | ||||||
4 | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and | ||||||
5 | XXXIIB of the Illinois Insurance Code.
| ||||||
6 | (b) For purposes of the Illinois Insurance Code, except | ||||||
7 | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | ||||||
8 | Health Maintenance Organizations in
the following categories | ||||||
9 | are deemed to be "domestic companies":
| ||||||
10 | (1) a corporation authorized under the
Dental Service | ||||||
11 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
12 | (2) a corporation organized under the laws of this | ||||||
13 | State; or
| ||||||
14 | (3) a corporation organized under the laws of another | ||||||
15 | state, 30% or more
of the enrollees of which are residents | ||||||
16 | of this State, except a
corporation subject to | ||||||
17 | substantially the same requirements in its state of
| ||||||
18 | organization as is a "domestic company" under Article VIII | ||||||
19 | 1/2 of the
Illinois Insurance Code.
| ||||||
20 | (c) In considering the merger, consolidation, or other | ||||||
21 | acquisition of
control of a Health Maintenance Organization | ||||||
22 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
23 | (1) the Director shall give primary consideration to | ||||||
24 | the continuation of
benefits to enrollees and the | ||||||
25 | financial conditions of the acquired Health
Maintenance | ||||||
26 | Organization after the merger, consolidation, or other
|
| |||||||
| |||||||
1 | acquisition of control takes effect;
| ||||||
2 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
3 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
4 | apply and (ii) the Director, in making
his determination | ||||||
5 | with respect to the merger, consolidation, or other
| ||||||
6 | acquisition of control, need not take into account the | ||||||
7 | effect on
competition of the merger, consolidation, or | ||||||
8 | other acquisition of control;
| ||||||
9 | (3) the Director shall have the power to require the | ||||||
10 | following
information:
| ||||||
11 | (A) certification by an independent actuary of the | ||||||
12 | adequacy
of the reserves of the Health Maintenance | ||||||
13 | Organization sought to be acquired;
| ||||||
14 | (B) pro forma financial statements reflecting the | ||||||
15 | combined balance
sheets of the acquiring company and | ||||||
16 | the Health Maintenance Organization sought
to be | ||||||
17 | acquired as of the end of the preceding year and as of | ||||||
18 | a date 90 days
prior to the acquisition, as well as pro | ||||||
19 | forma financial statements
reflecting projected | ||||||
20 | combined operation for a period of 2 years;
| ||||||
21 | (C) a pro forma business plan detailing an | ||||||
22 | acquiring party's plans with
respect to the operation | ||||||
23 | of the Health Maintenance Organization sought to
be | ||||||
24 | acquired for a period of not less than 3 years; and
| ||||||
25 | (D) such other information as the Director shall | ||||||
26 | require.
|
| |||||||
| |||||||
1 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
2 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
3 | any health maintenance
organization of greater than 10% of its
| ||||||
4 | enrollee population (including without limitation the health | ||||||
5 | maintenance
organization's right, title, and interest in and | ||||||
6 | to its health care
certificates).
| ||||||
7 | (e) In considering any management contract or service | ||||||
8 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
9 | Code, the Director (i) shall, in
addition to the criteria | ||||||
10 | specified in Section 141.2 of the Illinois
Insurance Code, | ||||||
11 | take into account the effect of the management contract or
| ||||||
12 | service agreement on the continuation of benefits to enrollees | ||||||
13 | and the
financial condition of the health maintenance | ||||||
14 | organization to be managed or
serviced, and (ii) need not take | ||||||
15 | into account the effect of the management
contract or service | ||||||
16 | agreement on competition.
| ||||||
17 | (f) Except for small employer groups as defined in the | ||||||
18 | Small Employer
Rating, Renewability and Portability Health | ||||||
19 | Insurance Act and except for
medicare supplement policies as | ||||||
20 | defined in Section 363 of the Illinois
Insurance Code, a | ||||||
21 | Health Maintenance Organization may by contract agree with a
| ||||||
22 | group or other enrollment unit to effect refunds or charge | ||||||
23 | additional premiums
under the following terms and conditions:
| ||||||
24 | (i) the amount of, and other terms and conditions with | ||||||
25 | respect to, the
refund or additional premium are set forth | ||||||
26 | in the group or enrollment unit
contract agreed in advance |
| |||||||
| |||||||
1 | of the period for which a refund is to be paid or
| ||||||
2 | additional premium is to be charged (which period shall | ||||||
3 | not be less than one
year); and
| ||||||
4 | (ii) the amount of the refund or additional premium | ||||||
5 | shall not exceed 20%
of the Health Maintenance | ||||||
6 | Organization's profitable or unprofitable experience
with | ||||||
7 | respect to the group or other enrollment unit for the | ||||||
8 | period (and, for
purposes of a refund or additional | ||||||
9 | premium, the profitable or unprofitable
experience shall | ||||||
10 | be calculated taking into account a pro rata share of the
| ||||||
11 | Health Maintenance Organization's administrative and | ||||||
12 | marketing expenses, but
shall not include any refund to be | ||||||
13 | made or additional premium to be paid
pursuant to this | ||||||
14 | subsection (f)). The Health Maintenance Organization and | ||||||
15 | the
group or enrollment unit may agree that the profitable | ||||||
16 | or unprofitable
experience may be calculated taking into | ||||||
17 | account the refund period and the
immediately preceding 2 | ||||||
18 | plan years.
| ||||||
19 | The Health Maintenance Organization shall include a | ||||||
20 | statement in the
evidence of coverage issued to each enrollee | ||||||
21 | describing the possibility of a
refund or additional premium, | ||||||
22 | and upon request of any group or enrollment unit,
provide to | ||||||
23 | the group or enrollment unit a description of the method used | ||||||
24 | to
calculate (1) the Health Maintenance Organization's | ||||||
25 | profitable experience with
respect to the group or enrollment | ||||||
26 | unit and the resulting refund to the group
or enrollment unit |
| |||||||
| |||||||
1 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
2 | experience with respect to the group or enrollment unit and | ||||||
3 | the resulting
additional premium to be paid by the group or | ||||||
4 | enrollment unit.
| ||||||
5 | In no event shall the Illinois Health Maintenance | ||||||
6 | Organization
Guaranty Association be liable to pay any | ||||||
7 | contractual obligation of an
insolvent organization to pay any | ||||||
8 | refund authorized under this Section.
| ||||||
9 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
10 | if any, is conditioned on the rules being adopted in | ||||||
11 | accordance with all provisions of the Illinois Administrative | ||||||
12 | Procedure Act and all rules and procedures of the Joint | ||||||
13 | Committee on Administrative Rules; any purported rule not so | ||||||
14 | adopted, for whatever reason, is unauthorized. | ||||||
15 | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | ||||||
16 | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. | ||||||
17 | 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, | ||||||
18 | eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||||||
19 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
20 | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | ||||||
21 | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | ||||||
22 | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | ||||||
23 | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | ||||||
24 | eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.) | ||||||
25 | Section 45. The Voluntary Health Services Plans Act is |
| |||||||
| |||||||
1 | amended by changing Section 10 as follows:
| ||||||
2 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
3 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
4 | services
plan corporations and all persons interested therein | ||||||
5 | or dealing therewith
shall be subject to the provisions of | ||||||
6 | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | ||||||
7 | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | ||||||
8 | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, | ||||||
9 | 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, | ||||||
10 | 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | ||||||
11 | 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | ||||||
12 | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | ||||||
13 | 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | ||||||
14 | 356z.56, 356z.57, 356z.59, 356z.60, 356z.62, 364.01, 364.3, | ||||||
15 | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | ||||||
16 | and paragraphs (7) and (15) of Section 367 of the Illinois
| ||||||
17 | Insurance Code.
| ||||||
18 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
19 | any, is conditioned on the rules being adopted in accordance | ||||||
20 | with all provisions of the Illinois Administrative Procedure | ||||||
21 | Act and all rules and procedures of the Joint Committee on | ||||||
22 | Administrative Rules; any purported rule not so adopted, for | ||||||
23 | whatever reason, is unauthorized. | ||||||
24 | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | ||||||
25 | 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. |
| |||||||
| |||||||
1 | 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, | ||||||
2 | eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; | ||||||
3 | 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff. | ||||||
4 | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, | ||||||
5 | eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23; | ||||||
6 | 102-1117, eff. 1-13-23.) | ||||||
7 | Section 50. The Medical Practice Act of 1987 is amended by | ||||||
8 | changing Section 18 as follows:
| ||||||
9 | (225 ILCS 60/18) (from Ch. 111, par. 4400-18)
| ||||||
10 | (Section scheduled to be repealed on January 1, 2027)
| ||||||
11 | Sec. 18. Visiting professor, physician, or resident | ||||||
12 | permits.
| ||||||
13 | (A) Visiting professor permit.
| ||||||
14 | (1) A visiting professor permit shall
entitle a person | ||||||
15 | to practice medicine in all of its branches
or to practice | ||||||
16 | the treatment of human ailments without the
use of drugs | ||||||
17 | and without operative surgery provided:
| ||||||
18 | (a) the person maintains an equivalent | ||||||
19 | authorization
to practice medicine in all of its | ||||||
20 | branches or to practice
the treatment of human | ||||||
21 | ailments without the use of drugs
and without | ||||||
22 | operative surgery in good standing in his or her
| ||||||
23 | native licensing jurisdiction during the period of the
| ||||||
24 | visiting professor permit;
|
| |||||||
| |||||||
1 | (b) the person has received a faculty appointment | ||||||
2 | to
teach in a medical, osteopathic or chiropractic | ||||||
3 | school in
Illinois; and
| ||||||
4 | (c) the Department may prescribe the information | ||||||
5 | necessary to
establish
an applicant's eligibility for | ||||||
6 | a permit. This information shall include
without | ||||||
7 | limitation (i) a statement from the dean of the | ||||||
8 | medical school at which
the
applicant will be employed | ||||||
9 | describing the applicant's qualifications and (ii)
a | ||||||
10 | statement from the dean of the medical school listing | ||||||
11 | every affiliated
institution in which the applicant | ||||||
12 | will be providing instruction as part of the
medical | ||||||
13 | school's education program and justifying any clinical | ||||||
14 | activities at
each of the institutions listed by the | ||||||
15 | dean.
| ||||||
16 | (2) Application for visiting professor permits shall
| ||||||
17 | be made to the Department, in writing, on forms prescribed
| ||||||
18 | by the Department and shall be accompanied by the required
| ||||||
19 | fee established by rule, which shall not be refundable. | ||||||
20 | Any application
shall require the information as, in the | ||||||
21 | judgment of the Department, will
enable the Department to | ||||||
22 | pass on the qualifications of the applicant.
| ||||||
23 | (3) A visiting professor permit shall be valid for no | ||||||
24 | longer than 2
years from the date of issuance or until the | ||||||
25 | time the
faculty appointment is terminated, whichever | ||||||
26 | occurs first,
and may be renewed only in accordance with |
| |||||||
| |||||||
1 | subdivision (A)(6) of this
Section.
| ||||||
2 | (4) The applicant may be required to appear before the | ||||||
3 | Medical Board for an interview prior to, and as a
| ||||||
4 | requirement for, the issuance of the original permit and | ||||||
5 | the
renewal.
| ||||||
6 | (5) Persons holding a permit under this Section shall
| ||||||
7 | only practice medicine in all of its branches or practice
| ||||||
8 | the treatment of human ailments without the use of drugs
| ||||||
9 | and without operative surgery in the State of Illinois in
| ||||||
10 | their official capacity under their contract
within the | ||||||
11 | medical school itself and any affiliated institution in | ||||||
12 | which the
permit holder is providing instruction as part | ||||||
13 | of the medical school's
educational program and for which | ||||||
14 | the medical school has assumed direct
responsibility.
| ||||||
15 | (6) After the initial renewal of a visiting professor | ||||||
16 | permit, a visiting professor permit shall be valid until | ||||||
17 | the last day of the
next physician license renewal period, | ||||||
18 | as set by rule, and may only be
renewed for applicants who | ||||||
19 | meet the following requirements:
| ||||||
20 | (i) have obtained the required continuing | ||||||
21 | education hours as set by
rule; and
| ||||||
22 | (ii) have paid the fee prescribed for a license | ||||||
23 | under Section 21 of this
Act.
| ||||||
24 | For initial renewal, the visiting professor must | ||||||
25 | successfully pass a
general competency examination authorized | ||||||
26 | by the Department by rule, unless he or she was issued an |
| |||||||
| |||||||
1 | initial visiting professor permit on or after January 1, 2007, | ||||||
2 | but prior to July 1, 2007.
| ||||||
3 | (B) Visiting physician permit.
| ||||||
4 | (1) The Department may, in its discretion, issue a | ||||||
5 | temporary visiting
physician permit, without examination, | ||||||
6 | provided:
| ||||||
7 | (a) (blank);
| ||||||
8 | (b) that the person maintains an equivalent | ||||||
9 | authorization to practice
medicine in all of its | ||||||
10 | branches or to practice the treatment of human
| ||||||
11 | ailments without the use of drugs and without | ||||||
12 | operative surgery in good
standing in his or her | ||||||
13 | native licensing jurisdiction during the period of the
| ||||||
14 | temporary visiting physician permit;
| ||||||
15 | (c) that the person has received an invitation or | ||||||
16 | appointment to study,
demonstrate, or perform a
| ||||||
17 | specific medical, osteopathic, chiropractic or | ||||||
18 | clinical subject or
technique in a medical, | ||||||
19 | osteopathic, or chiropractic school, a state or | ||||||
20 | national medical, osteopathic, or chiropractic | ||||||
21 | professional association or society conference or | ||||||
22 | meeting, a hospital
licensed under the Hospital | ||||||
23 | Licensing Act, a hospital organized
under the | ||||||
24 | University of Illinois Hospital Act, or a facility | ||||||
25 | operated
pursuant to the Ambulatory Surgical Treatment |
| |||||||
| |||||||
1 | Center Act; and
| ||||||
2 | (d) that the temporary visiting physician permit | ||||||
3 | shall only permit the
holder to practice medicine in | ||||||
4 | all of its branches or practice the
treatment of human | ||||||
5 | ailments without the use of drugs and without | ||||||
6 | operative
surgery within the scope of the medical, | ||||||
7 | osteopathic, chiropractic, or
clinical studies, or in | ||||||
8 | conjunction with the state or national medical, | ||||||
9 | osteopathic, or chiropractic professional association | ||||||
10 | or society conference or meeting, for which the holder | ||||||
11 | was invited or appointed.
| ||||||
12 | (2) The application for the temporary visiting | ||||||
13 | physician permit shall be
made to the Department, in | ||||||
14 | writing, on forms prescribed by the
Department, and shall | ||||||
15 | be accompanied by the required fee established by
rule, | ||||||
16 | which shall not be refundable. The application shall | ||||||
17 | require
information that, in the judgment of the | ||||||
18 | Department, will enable the
Department to pass on the | ||||||
19 | qualification of the applicant, and the necessity
for the | ||||||
20 | granting of a temporary visiting physician permit.
| ||||||
21 | (3) A temporary visiting physician permit shall be | ||||||
22 | valid for no longer than (i) 180
days
from the date of | ||||||
23 | issuance or (ii) until the time the medical, osteopathic,
| ||||||
24 | chiropractic, or clinical studies are completed, or the | ||||||
25 | state or national medical, osteopathic, or chiropractic | ||||||
26 | professional association or society conference or meeting |
| |||||||
| |||||||
1 | has concluded, whichever occurs first. The temporary | ||||||
2 | visiting physician permit may be issued multiple times to | ||||||
3 | a visiting physician under this paragraph (3) as long as | ||||||
4 | the total number of days it is active do not exceed 180 | ||||||
5 | days within a 365-day period.
| ||||||
6 | (4) The applicant for a temporary visiting physician | ||||||
7 | permit may be
required to appear before the Medical Board | ||||||
8 | for an interview
prior to, and as a requirement for, the | ||||||
9 | issuance of a temporary visiting
physician permit.
| ||||||
10 | (5) A limited temporary visiting physician permit | ||||||
11 | shall be issued to a
physician licensed in another state | ||||||
12 | who has been requested to perform emergency
procedures in | ||||||
13 | Illinois if he or she meets the requirements as | ||||||
14 | established by
rule.
| ||||||
15 | (C) Visiting resident permit.
| ||||||
16 | (1) The Department may, in its discretion, issue a | ||||||
17 | temporary visiting
resident permit, without examination, | ||||||
18 | provided:
| ||||||
19 | (a) (blank);
| ||||||
20 | (b) that the person maintains an equivalent | ||||||
21 | authorization to practice
medicine in all of its | ||||||
22 | branches or to practice the treatment of human
| ||||||
23 | ailments without the use of drugs and without | ||||||
24 | operative surgery in good
standing in his or her | ||||||
25 | native licensing jurisdiction during the period of
the |
| |||||||
| |||||||
1 | temporary visiting resident permit;
| ||||||
2 | (c) that the applicant is enrolled in a | ||||||
3 | postgraduate clinical training
program outside the | ||||||
4 | State of Illinois that is approved by the Department;
| ||||||
5 | (d) that the individual has been invited or | ||||||
6 | appointed for a specific
period of time to perform a | ||||||
7 | portion of that post graduate clinical training
| ||||||
8 | program under the supervision of an Illinois licensed | ||||||
9 | physician in an
Illinois patient care clinic or | ||||||
10 | facility that is affiliated with the
out-of-State post | ||||||
11 | graduate training program; and
| ||||||
12 | (e) that the temporary visiting resident permit | ||||||
13 | shall only permit the
holder to practice medicine in | ||||||
14 | all of its branches or practice the
treatment of human | ||||||
15 | ailments without the use of drugs and without | ||||||
16 | operative
surgery within the scope of the medical, | ||||||
17 | osteopathic, chiropractic or
clinical studies for | ||||||
18 | which the holder was invited or appointed.
| ||||||
19 | (2) The application for the temporary visiting | ||||||
20 | resident permit shall be
made to the Department, in | ||||||
21 | writing, on forms prescribed by the Department,
and shall | ||||||
22 | be accompanied by the required fee established by rule. | ||||||
23 | The
application shall require information that, in the | ||||||
24 | judgment of the
Department, will enable the Department to | ||||||
25 | pass on the qualifications of
the applicant.
| ||||||
26 | (3) A temporary visiting resident permit shall be |
| |||||||
| |||||||
1 | valid for 180 days from
the date of issuance or until the | ||||||
2 | time the medical, osteopathic,
chiropractic, or clinical | ||||||
3 | studies are completed, whichever occurs first.
| ||||||
4 | (4) The applicant for a temporary visiting resident | ||||||
5 | permit may be
required to appear before the Medical Board | ||||||
6 | for an interview
prior to, and as a requirement for, the | ||||||
7 | issuance of a temporary visiting
resident permit. | ||||||
8 | (D) Postgraduate training exemption period; visiting | ||||||
9 | rotations. A person may participate in visiting rotations in | ||||||
10 | an approved postgraduate training program, not to exceed a | ||||||
11 | total of 90 days for all rotations, if the following | ||||||
12 | information is submitted in writing or electronically to the | ||||||
13 | Department by the patient care clinics or facilities where the | ||||||
14 | person will be performing the training or by an affiliated | ||||||
15 | program: | ||||||
16 | (1) The person who has been invited or appointed to | ||||||
17 | perform a portion of their postgraduate clinical training | ||||||
18 | program in Illinois. | ||||||
19 | (2) The name and address of the primary patient care | ||||||
20 | clinic or facility, the date the training is to begin, and | ||||||
21 | the length of time of the invitation or appointment. | ||||||
22 | (3) The name and license number of the Illinois | ||||||
23 | physician who will be responsible for supervising the | ||||||
24 | trainee and the medical director or division director of | ||||||
25 | the department or facility. |
| |||||||
| |||||||
1 | (4) Certification from the postgraduate training | ||||||
2 | program that the person is approved and enrolled in an | ||||||
3 | graduate training program approved by the Department in | ||||||
4 | their home state.
| ||||||
5 | (Source: P.A. 102-20, eff. 1-1-22 .)
| ||||||
6 | Section 95. No acceleration or delay. Where this Act makes | ||||||
7 | changes in a statute that is represented in this Act by text | ||||||
8 | that is not yet or no longer in effect (for example, a Section | ||||||
9 | represented by multiple versions), the use of that text does | ||||||
10 | not accelerate or delay the taking effect of (i) the changes | ||||||
11 | made by this Act or (ii) provisions derived from any other | ||||||
12 | Public Act. | ||||||
13 | Section 99. Effective date. This Act takes effect upon | ||||||
14 | becoming law.".
|