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| | SB2697 Enrolled | | LRB103 35895 RPS 65980 b |
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1 | | AN ACT concerning regulation. |
2 | | Be it enacted by the People of the State of Illinois, |
3 | | represented in the General Assembly: |
4 | | Section 5. The State Employees Group Insurance Act of 1971 |
5 | | is amended by changing Section 6.11 as follows: |
6 | | (5 ILCS 375/6.11) |
7 | | Sec. 6.11. Required health benefits; Illinois Insurance |
8 | | Code requirements. The program of health benefits shall |
9 | | provide the post-mastectomy care benefits required to be |
10 | | covered by a policy of accident and health insurance under |
11 | | Section 356t of the Illinois Insurance Code. The program of |
12 | | health benefits shall provide the coverage required under |
13 | | Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, |
14 | | 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, |
15 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, |
16 | | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, |
17 | | 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, |
18 | | 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, |
19 | | 356z.60, and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, |
20 | | and 356z.70 of the Illinois Insurance Code. The program of |
21 | | health benefits must comply with Sections 155.22a, 155.37, |
22 | | 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the |
23 | | Illinois Insurance Code. The program of health benefits shall |
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1 | | provide the coverage required under Section 356m of the |
2 | | Illinois Insurance Code and, for the employees of the State |
3 | | Employee Group Insurance Program only, the coverage as also |
4 | | provided in Section 6.11B of this Act. The Department of |
5 | | Insurance shall enforce the requirements of this Section with |
6 | | respect to Sections 370c and 370c.1 of the Illinois Insurance |
7 | | Code; all other requirements of this Section shall be enforced |
8 | | by the Department of Central Management Services. |
9 | | Rulemaking authority to implement Public Act 95-1045, if |
10 | | any, is conditioned on the rules being adopted in accordance |
11 | | with all provisions of the Illinois Administrative Procedure |
12 | | Act and all rules and procedures of the Joint Committee on |
13 | | Administrative Rules; any purported rule not so adopted, for |
14 | | whatever reason, is unauthorized. |
15 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
16 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. |
17 | | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, |
18 | | eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
19 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
20 | | 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, |
21 | | eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; |
22 | | 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. |
23 | | 8-11-23; revised 8-29-23.) |
24 | | Section 10. The Counties Code is amended by changing |
25 | | Section 5-1069.3 as follows: |
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1 | | (55 ILCS 5/5-1069.3) |
2 | | Sec. 5-1069.3. Required health benefits. If a county, |
3 | | including a home rule county, is a self-insurer for purposes |
4 | | of providing health insurance coverage for its employees, the |
5 | | coverage shall include coverage for the post-mastectomy care |
6 | | benefits required to be covered by a policy of accident and |
7 | | health insurance under Section 356t and the coverage required |
8 | | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356u.10, |
9 | | 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, |
10 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, |
11 | | 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, |
12 | | 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, |
13 | | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and |
14 | | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 |
15 | | of the Illinois Insurance Code. The coverage shall comply with |
16 | | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois |
17 | | Insurance Code. The Department of Insurance shall enforce the |
18 | | requirements of this Section. The requirement that health |
19 | | benefits be covered as provided in this Section is an |
20 | | exclusive power and function of the State and is a denial and |
21 | | limitation under Article VII, Section 6, subsection (h) of the |
22 | | Illinois Constitution. A home rule county to which this |
23 | | Section applies must comply with every provision of this |
24 | | Section. |
25 | | Rulemaking authority to implement Public Act 95-1045, if |
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1 | | any, is conditioned on the rules being adopted in accordance |
2 | | with all provisions of the Illinois Administrative Procedure |
3 | | Act and all rules and procedures of the Joint Committee on |
4 | | Administrative Rules; any purported rule not so adopted, for |
5 | | whatever reason, is unauthorized. |
6 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
7 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
8 | | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, |
9 | | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
10 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
11 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
12 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
13 | | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised |
14 | | 8-29-23.) |
15 | | Section 15. The Illinois Municipal Code is amended by |
16 | | changing Section 10-4-2.3 as follows: |
17 | | (65 ILCS 5/10-4-2.3) |
18 | | Sec. 10-4-2.3. Required health benefits. If a |
19 | | municipality, including a home rule municipality, is a |
20 | | self-insurer for purposes of providing health insurance |
21 | | coverage for its employees, the coverage shall include |
22 | | coverage for the post-mastectomy care benefits required to be |
23 | | covered by a policy of accident and health insurance under |
24 | | Section 356t and the coverage required under Sections 356g, |
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1 | | 356g.5, 356g.5-1, 356q, 356u, 356u.10, 356w, 356x, 356z.4, |
2 | | 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, |
3 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, |
4 | | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, |
5 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, |
6 | | 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , |
7 | | 356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois |
8 | | Insurance Code. The coverage shall comply with Sections |
9 | | 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance |
10 | | Code. The Department of Insurance shall enforce the |
11 | | requirements of this Section. The requirement that health |
12 | | benefits be covered as provided in this is an exclusive power |
13 | | and function of the State and is a denial and limitation under |
14 | | Article VII, Section 6, subsection (h) of the Illinois |
15 | | Constitution. A home rule municipality to which this Section |
16 | | applies must comply with every provision of this Section. |
17 | | Rulemaking authority to implement Public Act 95-1045, if |
18 | | any, is conditioned on the rules being adopted in accordance |
19 | | with all provisions of the Illinois Administrative Procedure |
20 | | Act and all rules and procedures of the Joint Committee on |
21 | | Administrative Rules; any purported rule not so adopted, for |
22 | | whatever reason, is unauthorized. |
23 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
24 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
25 | | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, |
26 | | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
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1 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
2 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
3 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
4 | | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised |
5 | | 8-29-23.) |
6 | | Section 20. The School Code is amended by changing Section |
7 | | 10-22.3f as follows: |
8 | | (105 ILCS 5/10-22.3f) |
9 | | Sec. 10-22.3f. Required health benefits. Insurance |
10 | | protection and benefits for employees shall provide the |
11 | | post-mastectomy care benefits required to be covered by a |
12 | | policy of accident and health insurance under Section 356t and |
13 | | the coverage required under Sections 356g, 356g.5, 356g.5-1, |
14 | | 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, |
15 | | 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, |
16 | | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, |
17 | | 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, |
18 | | 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, |
19 | | and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and |
20 | | 356z.70 of the Illinois Insurance Code. Insurance policies |
21 | | shall comply with Section 356z.19 of the Illinois Insurance |
22 | | Code. The coverage shall comply with Sections 155.22a, 355b, |
23 | | and 370c of the Illinois Insurance Code. The Department of |
24 | | Insurance shall enforce the requirements of this Section. |
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1 | | Rulemaking authority to implement Public Act 95-1045, if |
2 | | any, is conditioned on the rules being adopted in accordance |
3 | | with all provisions of the Illinois Administrative Procedure |
4 | | Act and all rules and procedures of the Joint Committee on |
5 | | Administrative Rules; any purported rule not so adopted, for |
6 | | whatever reason, is unauthorized. |
7 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
8 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. |
9 | | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, |
10 | | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; |
11 | | 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. |
12 | | 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, |
13 | | eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; |
14 | | 103-551, eff. 8-11-23; revised 8-29-23.) |
15 | | Section 25. The Illinois Insurance Code is amended by |
16 | | adding Section 356u.10 as follows: |
17 | | (215 ILCS 5/356u.10 new) |
18 | | Sec. 356u.10. Genetic testing and evidence-based |
19 | | screenings for an inherited gene mutation. |
20 | | (a) In this Section, "genetic testing for an inherited |
21 | | mutation" means germline multi-gene testing for an inherited |
22 | | mutation associated with an increased risk of cancer in |
23 | | accordance with evidence-based, clinical practice guidelines. |
24 | | (b) A group policy of accident and health insurance or |
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1 | | managed care plan that is amended, delivered, issued, or |
2 | | renewed after January 1, 2026 shall provide coverage for |
3 | | clinical genetic testing for an inherited gene mutation for |
4 | | individuals with a personal or family history of cancer, as |
5 | | recommended by a health care professional in accordance with |
6 | | current evidence-based clinical practice guidelines, |
7 | | including, but not limited to, the current version of the |
8 | | National Comprehensive Cancer Network clinical practice |
9 | | guidelines. The coverage shall limit the total amount that a |
10 | | covered person is required to pay for a clinical genetic test |
11 | | under this subsection to an amount not to exceed $50, except |
12 | | for services for which cost sharing is prohibited under 42 |
13 | | U.S.C. 300gg-13. This subsection (b) shall not apply to |
14 | | coverage of genetic testing to the extent such coverage would |
15 | | disqualify a high-deductible health plan from eligibility for |
16 | | a health savings account pursuant to Section 223 of the |
17 | | Internal Revenue Code. |
18 | | (c) For individuals with a genetic test that is positive |
19 | | for an inherited mutation associated with an increased risk of |
20 | | cancer, coverage required under this Section shall include any |
21 | | evidence-based screenings, as recommended by a health care |
22 | | professional in accordance with current evidence-based |
23 | | clinical practice guidelines, to the extent that the |
24 | | management recommendation is not already covered by the |
25 | | policy, except that coverage for evidence-based screenings |
26 | | under this subsection (c) may be subject to a deductible, |
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1 | | coinsurance, or other cost-sharing limitation so long as the |
2 | | limitation is not greater than that required for other related |
3 | | cancer risk management benefits covered under the policy. In |
4 | | this subsection, "evidence-based cancer screenings" means |
5 | | medically recommended evidence-based screening modalities in |
6 | | accordance with current clinical practice guidelines. |
7 | | Section 30. The Health Maintenance Organization Act is |
8 | | amended by changing Section 5-3 as follows: |
9 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) |
10 | | Sec. 5-3. Insurance Code provisions. |
11 | | (a) Health Maintenance Organizations shall be subject to |
12 | | the provisions of Sections 133, 134, 136, 137, 139, 140, |
13 | | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, |
14 | | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, |
15 | | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356u.10, |
16 | | 356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, |
17 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
18 | | 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, |
19 | | 356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, |
20 | | 356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, |
21 | | 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, |
22 | | 356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, |
23 | | 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, |
24 | | 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, |
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1 | | 356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, |
2 | | 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, |
3 | | 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of |
4 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2, |
5 | | XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the |
6 | | Illinois Insurance Code. |
7 | | (b) For purposes of the Illinois Insurance Code, except |
8 | | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, |
9 | | Health Maintenance Organizations in the following categories |
10 | | are deemed to be "domestic companies": |
11 | | (1) a corporation authorized under the Dental Service |
12 | | Plan Act or the Voluntary Health Services Plans Act; |
13 | | (2) a corporation organized under the laws of this |
14 | | State; or |
15 | | (3) a corporation organized under the laws of another |
16 | | state, 30% or more of the enrollees of which are residents |
17 | | of this State, except a corporation subject to |
18 | | substantially the same requirements in its state of |
19 | | organization as is a "domestic company" under Article VIII |
20 | | 1/2 of the Illinois Insurance Code. |
21 | | (c) In considering the merger, consolidation, or other |
22 | | acquisition of control of a Health Maintenance Organization |
23 | | pursuant to Article VIII 1/2 of the Illinois Insurance Code, |
24 | | (1) the Director shall give primary consideration to |
25 | | the continuation of benefits to enrollees and the |
26 | | financial conditions of the acquired Health Maintenance |
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1 | | Organization after the merger, consolidation, or other |
2 | | acquisition of control takes effect; |
3 | | (2)(i) the criteria specified in subsection (1)(b) of |
4 | | Section 131.8 of the Illinois Insurance Code shall not |
5 | | apply and (ii) the Director, in making his determination |
6 | | with respect to the merger, consolidation, or other |
7 | | acquisition of control, need not take into account the |
8 | | effect on competition of the merger, consolidation, or |
9 | | other acquisition of control; |
10 | | (3) the Director shall have the power to require the |
11 | | following information: |
12 | | (A) certification by an independent actuary of the |
13 | | adequacy of the reserves of the Health Maintenance |
14 | | Organization sought to be acquired; |
15 | | (B) pro forma financial statements reflecting the |
16 | | combined balance sheets of the acquiring company and |
17 | | the Health Maintenance Organization sought to be |
18 | | acquired as of the end of the preceding year and as of |
19 | | a date 90 days prior to the acquisition, as well as pro |
20 | | forma financial statements reflecting projected |
21 | | combined operation for a period of 2 years; |
22 | | (C) a pro forma business plan detailing an |
23 | | acquiring party's plans with respect to the operation |
24 | | of the Health Maintenance Organization sought to be |
25 | | acquired for a period of not less than 3 years; and |
26 | | (D) such other information as the Director shall |
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1 | | require. |
2 | | (d) The provisions of Article VIII 1/2 of the Illinois |
3 | | Insurance Code and this Section 5-3 shall apply to the sale by |
4 | | any health maintenance organization of greater than 10% of its |
5 | | enrollee population (including , without limitation , the health |
6 | | maintenance organization's right, title, and interest in and |
7 | | to its health care certificates). |
8 | | (e) In considering any management contract or service |
9 | | agreement subject to Section 141.1 of the Illinois Insurance |
10 | | Code, the Director (i) shall, in addition to the criteria |
11 | | specified in Section 141.2 of the Illinois Insurance Code, |
12 | | take into account the effect of the management contract or |
13 | | service agreement on the continuation of benefits to enrollees |
14 | | and the financial condition of the health maintenance |
15 | | organization to be managed or serviced, and (ii) need not take |
16 | | into account the effect of the management contract or service |
17 | | agreement on competition. |
18 | | (f) Except for small employer groups as defined in the |
19 | | Small Employer Rating, Renewability and Portability Health |
20 | | Insurance Act and except for medicare supplement policies as |
21 | | defined in Section 363 of the Illinois Insurance Code, a |
22 | | Health Maintenance Organization may by contract agree with a |
23 | | group or other enrollment unit to effect refunds or charge |
24 | | additional premiums under the following terms and conditions: |
25 | | (i) the amount of, and other terms and conditions with |
26 | | respect to, the refund or additional premium are set forth |
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1 | | in the group or enrollment unit contract agreed in advance |
2 | | of the period for which a refund is to be paid or |
3 | | additional premium is to be charged (which period shall |
4 | | not be less than one year); and |
5 | | (ii) the amount of the refund or additional premium |
6 | | shall not exceed 20% of the Health Maintenance |
7 | | Organization's profitable or unprofitable experience with |
8 | | respect to the group or other enrollment unit for the |
9 | | period (and, for purposes of a refund or additional |
10 | | premium, the profitable or unprofitable experience shall |
11 | | be calculated taking into account a pro rata share of the |
12 | | Health Maintenance Organization's administrative and |
13 | | marketing expenses, but shall not include any refund to be |
14 | | made or additional premium to be paid pursuant to this |
15 | | subsection (f)). The Health Maintenance Organization and |
16 | | the group or enrollment unit may agree that the profitable |
17 | | or unprofitable experience may be calculated taking into |
18 | | account the refund period and the immediately preceding 2 |
19 | | plan years. |
20 | | The Health Maintenance Organization shall include a |
21 | | statement in the evidence of coverage issued to each enrollee |
22 | | describing the possibility of a refund or additional premium, |
23 | | and upon request of any group or enrollment unit, provide to |
24 | | the group or enrollment unit a description of the method used |
25 | | to calculate (1) the Health Maintenance Organization's |
26 | | profitable experience with respect to the group or enrollment |
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1 | | unit and the resulting refund to the group or enrollment unit |
2 | | or (2) the Health Maintenance Organization's unprofitable |
3 | | experience with respect to the group or enrollment unit and |
4 | | the resulting additional premium to be paid by the group or |
5 | | enrollment unit. |
6 | | In no event shall the Illinois Health Maintenance |
7 | | Organization Guaranty Association be liable to pay any |
8 | | contractual obligation of an insolvent organization to pay any |
9 | | refund authorized under this Section. |
10 | | (g) Rulemaking authority to implement Public Act 95-1045, |
11 | | if any, is conditioned on the rules being adopted in |
12 | | accordance with all provisions of the Illinois Administrative |
13 | | Procedure Act and all rules and procedures of the Joint |
14 | | Committee on Administrative Rules; any purported rule not so |
15 | | adopted, for whatever reason, is unauthorized. |
16 | | (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
17 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
18 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
19 | | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; |
20 | | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. |
21 | | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, |
22 | | eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; |
23 | | 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. |
24 | | 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, |
25 | | eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.) |
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1 | | Section 35. The Voluntary Health Services Plans Act is |
2 | | amended by changing Section 10 as follows: |
3 | | (215 ILCS 165/10) (from Ch. 32, par. 604) |
4 | | Sec. 10. Application of Insurance Code provisions. Health |
5 | | services plan corporations and all persons interested therein |
6 | | or dealing therewith shall be subject to the provisions of |
7 | | Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, |
8 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, |
9 | | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356u.10, 356v, |
10 | | 356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, |
11 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, |
12 | | 356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, |
13 | | 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, |
14 | | 356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, |
15 | | 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, |
16 | | 356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, |
17 | | 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) |
18 | | and (15) of Section 367 of the Illinois Insurance Code. |
19 | | Rulemaking authority to implement Public Act 95-1045, if |
20 | | any, is conditioned on the rules being adopted in accordance |
21 | | with all provisions of the Illinois Administrative Procedure |
22 | | Act and all rules and procedures of the Joint Committee on |
23 | | Administrative Rules; any purported rule not so adopted, for |
24 | | whatever reason, is unauthorized. |
25 | | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; |
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1 | | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. |
2 | | 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, |
3 | | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; |
4 | | 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. |
5 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
6 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
7 | | 103-551, eff. 8-11-23; revised 8-29-23.) |
8 | | Section 40. The Illinois Public Aid Code is amended by |
9 | | adding Section 5-52 as follows: |
10 | | (305 ILCS 5/5-52 new) |
11 | | Sec. 5-52. Genetic testing and evidence-based screenings |
12 | | for an inherited gene mutation. |
13 | | (a) In this Section, "genetic testing for an inherited |
14 | | mutation" means germline multi-gene testing for an inherited |
15 | | mutation associated with an increased risk of cancer in |
16 | | accordance with evidence-based, clinical practice guidelines. |
17 | | (b) Subject to federal approval, the medical assistance |
18 | | program, after January 1, 2026, shall provide coverage for |
19 | | clinical genetic testing for an inherited gene mutation for |
20 | | individuals with a personal or family history of cancer, as |
21 | | recommended by a health care professional in accordance with |
22 | | current evidence-based clinical practice guidelines, |
23 | | including, but not limited to, the current version of the |
24 | | National Comprehensive Cancer Network clinical practice |
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1 | | guidelines. |
2 | | (c) For individuals with a genetic test that is positive |
3 | | for an inherited mutation associated with an increased risk of |
4 | | cancer, coverage required under this Section shall include any |
5 | | evidence-based screenings, as recommended by a health care |
6 | | professional in accordance with current evidence-based |
7 | | clinical practice guidelines, to the extent that the |
8 | | management recommendation is not already covered by the |
9 | | medical assistance program. In this subsection, |
10 | | "evidence-based cancer screenings" means medically recommended |
11 | | evidence-based screening modalities in accordance with current |
12 | | clinical practice guidelines. |
13 | | Section 99. Effective date. This Section and Section 40 |
14 | | take effect January 1, 2025. |