Rep. Greg Harris

Filed: 3/9/2011

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 1191

2    AMENDMENT NO. ______. Amend House Bill 1191 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, and 356z.17, and 364.01 of the Illinois
16Insurance Code. The program of health benefits must comply with

 

 

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1Section 155.37 of the Illinois Insurance Code.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
995-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
106-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044,
11eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
1296-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
1396-1000, eff. 7-2-10.)
 
14    Section 10. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes of
19providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

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1356z.14, and 356z.15, and 364.01 of the Illinois Insurance
2Code. The requirement that health benefits be covered as
3provided in this Section is an exclusive power and function of
4the State and is a denial and limitation under Article VII,
5Section 6, subsection (h) of the Illinois Constitution. A home
6rule county to which this Section applies must comply with
7every provision 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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1595-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
166-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
17eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
1896-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
19    Section 15. The Illinois Municipal Code is amended by
20changing Section 10-4-2.3 as follows:
 
21    (65 ILCS 5/10-4-2.3)
22    Sec. 10-4-2.3. Required health benefits. If a
23municipality, including a home rule municipality, is a
24self-insurer for purposes of providing health insurance

 

 

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1coverage for its employees, the coverage shall include coverage
2for the post-mastectomy care benefits required to be covered by
3a policy of accident and health insurance under Section 356t
4and the coverage required under Sections 356g, 356g.5,
5356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
6356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 364.01 of
7the Illinois Insurance Code. The requirement that health
8benefits be covered as provided in this is an exclusive power
9and function of the State and is a denial and limitation under
10Article VII, Section 6, subsection (h) of the Illinois
11Constitution. A home rule municipality to which this Section
12applies must comply with every provision of this Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
2095-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
216-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
22eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
2396-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
24    Section 20. The School Code is amended by changing Section
2510-22.3f as follows:
 

 

 

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1    (105 ILCS 5/10-22.3f)
2    Sec. 10-22.3f. Required health benefits. Insurance
3protection and benefits for employees shall provide the
4post-mastectomy care benefits required to be covered by a
5policy of accident and health insurance under Section 356t and
6the coverage required under Sections 356g, 356g.5, 356g.5-1,
7356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
8356z.13, 356z.14, and 356z.15, and 364.01 of the Illinois
9Insurance Code.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1795-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
1895-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
191-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000,
20eff. 7-2-10.)
 
21    Section 25. The Illinois Insurance Code is amended by
22changing Section 364.01 as follows:
 
23    (215 ILCS 5/364.01)

 

 

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1    Sec. 364.01. Qualified clinical cancer trials.
2    (a) No individual or group policy of accident and health
3insurance issued or renewed in this State may be cancelled or
4non-renewed for any individual based on that individual's
5participation in a qualified clinical cancer trial.
6    (b) Qualified clinical cancer trials must meet the
7following criteria:
8        (1) the effectiveness of the treatment has not been
9    determined relative to established therapies;
10        (2) the trial is under clinical investigation as part
11    of an approved cancer research trial in Phase II, Phase
12    III, or Phase IV of investigation;
13        (3) the trial is:
14            (A) approved by the Food and Drug Administration;
15        or
16            (B) approved and funded by the National Institutes
17        of Health, the Centers for Disease Control and
18        Prevention, the Agency for Healthcare Research and
19        Quality, the United States Department of Defense, the
20        United States Department of Veterans Affairs, or the
21        United States Department of Energy in the form of an
22        investigational new drug application, or a cooperative
23        group or center of any entity described in this
24        subdivision (B); and
25        (4) the patient's primary care physician, if any, is
26    involved in the coordination of care.

 

 

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1    (c) No group policy of accident and health insurance shall
2exclude coverage for any routine patient care administered to
3an insured who is a qualified individual participating in a
4qualified clinical cancer trial, if the policy covers that same
5routine patient care of insureds not enrolled in a qualified
6clinical cancer trial.
7    (d) The coverage that may not be excluded under subsection
8(c) of this Section is subject to all terms, conditions,
9restrictions, exclusions, and limitations that apply to the
10same routine patient care received by an insured not enrolled
11in a qualified clinical cancer trial, including the application
12of any authorization requirement, utilization review, or
13medical management practices.
14    (e) If the group policy of accident and health insurance
15uses a preferred provider program and a preferred provider
16provides routine patient care in connection with a qualified
17clinical cancer trial, then the insurer may require the insured
18to use the preferred provider if the preferred provider agrees
19to provide to the insured that routine patient care.
20    (f) A group policy of accident and health insurance with a
21preferred provider program shall reimburse:
22        (1) a preferred provider for routine patient care in
23    connection with a qualified clinical cancer trial at the
24    preferred provider's negotiated rate, less any applicable
25    insured cost sharing; and
26        (2) a nonpreferred provider at rates comparable to

 

 

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1    negotiated rates for preferred providers; the nonpreferred
2    provider shall accept those amounts plus any applicable
3    copayments, coinsurance, and deductible as payment in full
4    for items billed.
5    The preferred provider and the nonpreferred provider may
6bill the insured any applicable deductible, copayment, and
7coinsurance.
8    (g) A qualified clinical cancer trial may not pay or refuse
9to pay for routine patient care of a individual participating
10in the trial, based in whole or in part on the person's having
11or not having coverage for routine patient care under a group
12policy of accident and health insurance.
13    (h) Nothing in this Section shall be construed to limit an
14insurer's coverage with respect to clinical trials.
15    (i) Nothing in this Section shall require coverage for
16out-of-network services where the underlying health benefit
17plan does not provide coverage for out-of-network services.
18    (j) As used in this Section, "routine patient care" means
19all health care services provided in the qualified clinical
20cancer trial that are otherwise generally covered under the
21policy if those items or services were not provided in
22connection with a qualified clinical cancer trial consistent
23with the standard of care for the treatment of cancer,
24including the type and frequency of any diagnostic modality,
25that a provider typically provides to a cancer patient who is
26not enrolled in a qualified clinical cancer trial. "Routine

 

 

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1patient care" does not include, and a group policy of accident
2and health insurance may exclude, coverage for:
3        (1) a health care service, item, or drug that is the
4    subject of the cancer clinical trial;
5        (2) a health care service, item, or drug provided
6    solely to satisfy data collection and analysis needs for
7    the qualified clinical cancer trial that is not used in the
8    direct clinical management of the patient;
9        (3) an investigational drug or device that has not been
10    approved for market by the United States Food and Drug
11    Administration;
12        (4) transportation, lodging, food, or other expenses
13    for the patient or a family member or companion of the
14    patient that are associated with the travel to or from a
15    facility providing the qualified clinical cancer trial;
16        (5) a health care service, item, or drug customarily
17    provided by the qualified clinical cancer trial sponsors
18    free of charge for any patient;
19        (6) a health care service or item, which except for the
20    fact that it is being provided in a qualified clinical
21    cancer trial, is otherwise specifically excluded from
22    coverage under the insured's policy, including:
23            (A) costs of extra treatments, services,
24        procedures, tests, or drugs that would not be performed
25        or administered except for the fact that the insured is
26        participating in the cancer clinical trial; and

 

 

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1            (B) costs of nonhealth care services that the
2        patient is required to receive as a result of
3        participation in the approved cancer clinical trial;
4        (7) the cost of an oncologic drug, if the qualified
5    clinical cancer trial's purpose is to study the use of the
6    oncologic drug in the particular cancer in question or
7    study the administration of the drug in a new manner;
8        (8) costs for services, items, or drugs that are
9    eligible for reimbursement from a source other than a
10    patient's contract or policy providing for third-party
11    payment or prepayment of health or medical expenses,
12    including the sponsor of the approved cancer clinical
13    trial; or
14        (9) costs associated with approved cancer clinical
15    trials designed exclusively to test toxicity or disease
16    pathophysiology; or
17        (10) a health care service or item that is eligible for
18    reimbursement by a source other than the insured's policy,
19    including the sponsor of the qualified clinical cancer
20    trial.
21    The definitions of the terms "health care services",
22"Non-Preferred Provider", "Preferred Provider", and "Preferred
23Provider Program", stated in 50 IL Adm. Code Part 2051
24Preferred Provider Programs apply to these terms in this
25Section.
26(Source: P.A. 93-1000, eff. 1-1-05.)".