Sen. David Koehler
Filed: 5/6/2013
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1 | AMENDMENT TO HOUSE BILL 3227
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2 | AMENDMENT NO. ______. Amend House Bill 3227 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Personnel Code is amended by changing | ||||||
5 | Section 4c as follows: | ||||||
6 | (20 ILCS 415/4c) (from Ch. 127, par. 63b104c) | ||||||
7 | Sec. 4c. General exemptions. The following positions in | ||||||
8 | State
service shall be exempt from jurisdictions A, B, and C, | ||||||
9 | unless the
jurisdictions shall be extended as provided in this | ||||||
10 | Act:
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11 | (1) All officers elected by the people.
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12 | (2) All positions under the Lieutenant Governor, | ||||||
13 | Secretary of State,
State Treasurer, State Comptroller, | ||||||
14 | State Board of Education, Clerk of
the Supreme Court,
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15 | Attorney General, and State Board of Elections.
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16 | (3) Judges, and officers and employees of the courts, |
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1 | and notaries
public.
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2 | (4) All officers and employees of the Illinois General | ||||||
3 | Assembly, all
employees of legislative commissions, all | ||||||
4 | officers and employees of the
Illinois Legislative | ||||||
5 | Reference Bureau, the Legislative
Research Unit, and the | ||||||
6 | Legislative Printing Unit.
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7 | (5) All positions in the Illinois National Guard and | ||||||
8 | Illinois State
Guard, paid from federal funds or positions
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9 | in the State Military Service filled by enlistment and paid | ||||||
10 | from State
funds.
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11 | (6) All employees of the Governor at the executive | ||||||
12 | mansion and on
his immediate personal staff.
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13 | (7) Directors of Departments, the Adjutant General, | ||||||
14 | the Assistant
Adjutant General, the Director of the | ||||||
15 | Illinois Emergency
Management Agency, members of boards | ||||||
16 | and commissions, and all other
positions appointed by the | ||||||
17 | Governor by and with the consent of the
Senate.
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18 | (8) The presidents, other principal administrative | ||||||
19 | officers, and
teaching, research and extension faculties | ||||||
20 | of
Chicago State University, Eastern Illinois University, | ||||||
21 | Governors State
University, Illinois State University, | ||||||
22 | Northeastern Illinois University,
Northern Illinois | ||||||
23 | University, Western Illinois University, the Illinois
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24 | Community College Board, Southern Illinois
University, | ||||||
25 | Illinois Board of Higher Education, University of
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26 | Illinois, State Universities Civil Service System, |
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1 | University Retirement
System of Illinois, and the | ||||||
2 | administrative officers and scientific and
technical staff | ||||||
3 | of the Illinois State Museum.
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4 | (9) All other employees except the presidents, other | ||||||
5 | principal
administrative officers, and teaching, research | ||||||
6 | and extension faculties
of the universities under the | ||||||
7 | jurisdiction of the Board of Regents and
the colleges and | ||||||
8 | universities under the jurisdiction of the Board of
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9 | Governors of State Colleges and Universities, Illinois | ||||||
10 | Community College
Board, Southern Illinois University, | ||||||
11 | Illinois Board of Higher Education,
Board of Governors of | ||||||
12 | State Colleges and Universities, the Board of
Regents, | ||||||
13 | University of Illinois, State Universities Civil Service
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14 | System, University Retirement System of Illinois, so long | ||||||
15 | as these are
subject to the provisions of the State | ||||||
16 | Universities Civil Service Act.
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17 | (10) The State Police so long as they are subject to | ||||||
18 | the merit
provisions of the State Police Act.
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19 | (11) (Blank).
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20 | (12) The technical and engineering staffs of the | ||||||
21 | Department of
Transportation, the Department of Nuclear | ||||||
22 | Safety, the Pollution Control
Board, and the Illinois | ||||||
23 | Commerce Commission, and the technical and engineering
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24 | staff providing architectural and engineering services in | ||||||
25 | the Department of
Central Management Services.
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26 | (13) All employees of the Illinois State Toll Highway |
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1 | Authority.
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2 | (14) The Secretary of the Illinois Workers' | ||||||
3 | Compensation Commission.
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4 | (15) All persons who are appointed or employed by the | ||||||
5 | Director of
Insurance under authority of Section 202 of the | ||||||
6 | Illinois Insurance Code
to assist the Director of Insurance | ||||||
7 | in discharging his responsibilities
relating to the | ||||||
8 | rehabilitation, liquidation, conservation, and
dissolution | ||||||
9 | of companies that are subject to the jurisdiction of the
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10 | Illinois Insurance Code.
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11 | (16) All employees of the St. Louis Metropolitan Area | ||||||
12 | Airport
Authority.
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13 | (17) All investment officers employed by the Illinois | ||||||
14 | State Board of
Investment.
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15 | (18) Employees of the Illinois Young Adult | ||||||
16 | Conservation Corps program,
administered by the Illinois | ||||||
17 | Department of Natural Resources, authorized
grantee under | ||||||
18 | Title VIII of the Comprehensive
Employment and Training Act | ||||||
19 | of 1973, 29 USC 993.
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20 | (19) Seasonal employees of the Department of | ||||||
21 | Agriculture for the
operation of the Illinois State Fair | ||||||
22 | and the DuQuoin State Fair, no one
person receiving more | ||||||
23 | than 29 days of such employment in any calendar year.
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24 | (20) All "temporary" employees hired under the | ||||||
25 | Department of Natural
Resources' Illinois Conservation | ||||||
26 | Service, a youth
employment program that hires young people |
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1 | to work in State parks for a period
of one year or less.
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2 | (21) All hearing officers of the Human Rights | ||||||
3 | Commission.
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4 | (22) All employees of the Illinois Mathematics and | ||||||
5 | Science Academy.
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6 | (23) All employees of the Kankakee River Valley Area
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7 | Airport Authority.
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8 | (24) The commissioners and employees of the Executive | ||||||
9 | Ethics
Commission.
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10 | (25) The Executive Inspectors General, including | ||||||
11 | special Executive
Inspectors General, and employees of | ||||||
12 | each Office of an
Executive Inspector General.
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13 | (26) The commissioners and employees of the | ||||||
14 | Legislative Ethics
Commission.
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15 | (27) The Legislative Inspector General, including | ||||||
16 | special Legislative
Inspectors General, and employees of | ||||||
17 | the Office of
the Legislative Inspector General.
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18 | (28) The Auditor General's Inspector General and | ||||||
19 | employees of the Office
of the Auditor General's Inspector | ||||||
20 | General.
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21 | (29) All employees of the Illinois Power Agency. | ||||||
22 | (30) Employees having demonstrable, defined advanced | ||||||
23 | skills in accounting, financial reporting, or technical | ||||||
24 | expertise who are employed within executive branch | ||||||
25 | agencies and whose duties are directly related to the | ||||||
26 | submission to the Office of the Comptroller of financial |
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1 | information for the publication of the Comprehensive | ||||||
2 | Annual Financial Report (CAFR). | ||||||
3 | (31) The employees of the Illinois Health Benefits | ||||||
4 | Exchange. | ||||||
5 | (Source: P.A. 97-618, eff. 10-26-11; 97-1055, eff. 8-23-12 .)
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6 | Section 10. The Illinois State Auditing Act is amended by | ||||||
7 | changing Section 3-1 as follows:
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8 | (30 ILCS 5/3-1) (from Ch. 15, par. 303-1)
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9 | Sec. 3-1. Jurisdiction of Auditor General. The Auditor | ||||||
10 | General has
jurisdiction over all State agencies to make post | ||||||
11 | audits and investigations
authorized by or under this Act or | ||||||
12 | the Constitution.
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13 | The Auditor General has jurisdiction over local government | ||||||
14 | agencies
and private agencies only:
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15 | (a) to make such post audits authorized by or under | ||||||
16 | this Act as are
necessary and incidental to a post audit of | ||||||
17 | a State agency or of a
program administered by a State | ||||||
18 | agency involving public funds of the
State, but this | ||||||
19 | jurisdiction does not include any authority to review
local | ||||||
20 | governmental agencies in the obligation, receipt, | ||||||
21 | expenditure or
use of public funds of the State that are | ||||||
22 | granted without limitation or
condition imposed by law, | ||||||
23 | other than the general limitation that such
funds be used | ||||||
24 | for public purposes;
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1 | (b) to make investigations authorized by or under this | ||||||
2 | Act or the
Constitution; and
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3 | (c) to make audits of the records of local government | ||||||
4 | agencies to verify
actual costs of state-mandated programs | ||||||
5 | when directed to do so by the
Legislative Audit Commission | ||||||
6 | at the request of the State Board of Appeals
under the | ||||||
7 | State Mandates Act.
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8 | In addition to the foregoing, the Auditor General may | ||||||
9 | conduct an
audit of the Metropolitan Pier and Exposition | ||||||
10 | Authority, the
Regional Transportation Authority, the Suburban | ||||||
11 | Bus Division, the Commuter
Rail Division and the Chicago | ||||||
12 | Transit Authority and any other subsidized
carrier when | ||||||
13 | authorized by the Legislative Audit Commission. Such audit
may | ||||||
14 | be a financial, management or program audit, or any combination | ||||||
15 | thereof.
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16 | The audit shall determine whether they are operating in | ||||||
17 | accordance with
all applicable laws and regulations. Subject to | ||||||
18 | the limitations of this
Act, the Legislative Audit Commission | ||||||
19 | may by resolution specify additional
determinations to be | ||||||
20 | included in the scope of the audit.
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21 | In addition to the foregoing, the Auditor General must also | ||||||
22 | conduct a
financial audit of
the Illinois Sports Facilities | ||||||
23 | Authority's expenditures of public funds in
connection with the | ||||||
24 | reconstruction, renovation, remodeling, extension, or
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25 | improvement of all or substantially all of any existing | ||||||
26 | "facility", as that
term is defined in the Illinois Sports |
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1 | Facilities Authority Act.
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2 | The Auditor General may also conduct an audit, when | ||||||
3 | authorized by
the Legislative Audit Commission, of any hospital | ||||||
4 | which receives 10% or
more of its gross revenues from payments | ||||||
5 | from the State of Illinois,
Department of Healthcare and Family | ||||||
6 | Services (formerly Department of Public Aid), Medical | ||||||
7 | Assistance Program.
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8 | The Auditor General is authorized to conduct financial and | ||||||
9 | compliance
audits of the Illinois Distance Learning Foundation | ||||||
10 | and the Illinois
Conservation Foundation.
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11 | As soon as practical after the effective date of this | ||||||
12 | amendatory Act of
1995, the Auditor General shall conduct a | ||||||
13 | compliance and management audit of
the City of
Chicago and any | ||||||
14 | other entity with regard to the operation of Chicago O'Hare
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15 | International Airport, Chicago Midway Airport and Merrill C. | ||||||
16 | Meigs Field. The
audit shall include, but not be limited to, an | ||||||
17 | examination of revenues,
expenses, and transfers of funds; | ||||||
18 | purchasing and contracting policies and
practices; staffing | ||||||
19 | levels; and hiring practices and procedures. When
completed, | ||||||
20 | the audit required by this paragraph shall be distributed in
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21 | accordance with Section 3-14.
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22 | The Auditor General shall conduct a financial and | ||||||
23 | compliance and program
audit of distributions from the | ||||||
24 | Municipal Economic Development Fund
during the immediately | ||||||
25 | preceding calendar year pursuant to Section 8-403.1 of
the | ||||||
26 | Public Utilities Act at no cost to the city, village, or |
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1 | incorporated town
that received the distributions.
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2 | The Auditor General must conduct an audit of the Health | ||||||
3 | Facilities and Services Review Board pursuant to Section 19.5 | ||||||
4 | of the Illinois Health Facilities Planning
Act.
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5 | The Auditor General of the State of Illinois shall annually | ||||||
6 | conduct or
cause to be conducted a financial and compliance | ||||||
7 | audit of the books and records
of any county water commission | ||||||
8 | organized pursuant to the Water Commission Act
of 1985 and | ||||||
9 | shall file a copy of the report of that audit with the Governor | ||||||
10 | and
the Legislative Audit Commission. The filed audit shall be | ||||||
11 | open to the public
for inspection. The cost of the audit shall | ||||||
12 | be charged to the county water
commission in accordance with | ||||||
13 | Section 6z-27 of the State Finance Act. The
county water | ||||||
14 | commission shall make available to the Auditor General its | ||||||
15 | books
and records and any other documentation, whether in the | ||||||
16 | possession of its
trustees or other parties, necessary to | ||||||
17 | conduct the audit required. These
audit requirements apply only | ||||||
18 | through July 1, 2007.
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19 | The Auditor General must conduct audits of the Rend Lake | ||||||
20 | Conservancy
District as provided in Section 25.5 of the River | ||||||
21 | Conservancy Districts Act.
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22 | The Auditor General must conduct financial audits of the | ||||||
23 | Southeastern Illinois Economic Development Authority as | ||||||
24 | provided in Section 70 of the Southeastern Illinois Economic | ||||||
25 | Development Authority Act.
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26 | The Auditor General shall conduct a compliance audit in |
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1 | accordance with subsections (d) and (f) of Section 30 of the | ||||||
2 | Innovation Development and Economy Act. | ||||||
3 | The Auditor General shall have the authority to conduct an | ||||||
4 | audit of the Illinois Health Benefits Exchange. The audit may | ||||||
5 | be a financial audit, a management audit, a program audit, or | ||||||
6 | any combination thereof. | ||||||
7 | (Source: P.A. 95-331, eff. 8-21-07; 96-31, eff. 6-30-09; | ||||||
8 | 96-939, eff. 6-24-10.)
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9 | Section 15. The Comprehensive Health Insurance Plan Act is | ||||||
10 | amended by adding Sections 16 and 17 as follows: | ||||||
11 | (215 ILCS 105/16 new) | ||||||
12 | Sec. 16. Cessation of operations. Notwithstanding any | ||||||
13 | other provision of this Act, the insurance operations of the | ||||||
14 | Plan authorized by this Act shall cease on January 1, 2014 in | ||||||
15 | accordance with Section 5-30 of the Illinois Health Benefits | ||||||
16 | Exchange Law. Plan coverage does not apply to service provided | ||||||
17 | on or after January 1, 2014 in accordance with Section 5-30 of | ||||||
18 | the Illinois Health Benefits Exchange Law. | ||||||
19 | (215 ILCS 105/17 new) | ||||||
20 | Sec. 17. Repealer. This Act is repealed on January 1, 2015. | ||||||
21 | Section 20. The Illinois Health Benefits Exchange Law is | ||||||
22 | amended by changing Sections 5-3, 5-5, and 5-15 and by adding |
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1 | Sections 5-4, 5-6, 5-16, 5-17, 5-18, 5-21, 5-23, and 5-30 as | ||||||
2 | follows: | ||||||
3 | (215 ILCS 122/5-3)
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4 | Sec. 5-3. Legislative intent. The General Assembly finds | ||||||
5 | the health benefits exchanges authorized by the federal Patient | ||||||
6 | Protection and Affordable Care Act represent one of a number of | ||||||
7 | ways in which the State can address coverage gaps and provide | ||||||
8 | individual consumers and small employers access to greater | ||||||
9 | coverage options. The General Assembly also finds that the | ||||||
10 | State is best positioned to implement an exchange that is | ||||||
11 | sensitive to the coverage gaps and market landscape unique to | ||||||
12 | this State. | ||||||
13 | The purpose of this Law is to provide for the establishment | ||||||
14 | of an Illinois Health Benefits Exchange (the Exchange) to | ||||||
15 | facilitate the purchase and sale of qualified health plans and | ||||||
16 | qualified dental plans in the individual market in this State | ||||||
17 | and to provide for the establishment of a Small Business Health | ||||||
18 | Options Program (SHOP Exchange) to assist qualified small | ||||||
19 | employers in this State in facilitating the enrollment of their | ||||||
20 | employees in qualified health plans and qualified dental plans | ||||||
21 | offered in the small group market. The intent of the Exchange | ||||||
22 | is to supplement the existing health insurance market to | ||||||
23 | simplify shopping for individual and small employers by | ||||||
24 | increasing access to benefit options, encouraging a | ||||||
25 | competitive market both inside and outside the Exchange, |
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1 | reducing the number of uninsured, and providing a transparent | ||||||
2 | marketplace and effective consumer education and programmatic | ||||||
3 | assistance tools. The purpose of this Law is to ensure that the | ||||||
4 | State is making sufficient progress towards establishing an | ||||||
5 | exchange within the guidelines outlined by the federal law and | ||||||
6 | to protect Illinoisans from undue federal regulation. Although | ||||||
7 | the federal law imposes a number of core requirements on | ||||||
8 | state-level exchanges, the State has significant flexibility | ||||||
9 | in the design and operation of a State exchange that make it | ||||||
10 | prudent for the State to carefully analyze, plan, and prepare | ||||||
11 | for the exchange. The General Assembly finds that in order for | ||||||
12 | the State to craft a tenable exchange that meets the | ||||||
13 | fundamental goals outlined by the Patient Protection and | ||||||
14 | Affordable Care Act of expanding access to affordable coverage | ||||||
15 | and improving the quality of care, the implementation process | ||||||
16 | should (1) provide for broad stakeholder representation; (2) | ||||||
17 | foster a robust and competitive marketplace, both inside and | ||||||
18 | outside of the exchange; and (3) provide for a broad-based | ||||||
19 | approach to the fiscal solvency of the exchange.
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20 | (Source: P.A. 97-142, eff. 7-14-11.) | ||||||
21 | (215 ILCS 122/5-4 new) | ||||||
22 | Sec. 5-4. Definitions. In this Law: | ||||||
23 | "Board" means the Illinois Health Benefits Exchange Board | ||||||
24 | established pursuant to this Law. | ||||||
25 | "Department" means the Department of Insurance. |
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1 | "Director" means the Director of Insurance. | ||||||
2 | "Educated health care consumer" means an individual who is | ||||||
3 | knowledgeable about the health care system, and has background | ||||||
4 | or experience in making informed decisions regarding health, | ||||||
5 | medical, and public health matters. | ||||||
6 | "Essential health benefits" has the meaning provided under | ||||||
7 | Section 1302(b) of the Federal Act. | ||||||
8 | "Exchange" means the Illinois Health Benefits Exchange | ||||||
9 | established by this Law and includes the Individual Exchange | ||||||
10 | and the SHOP Exchange, unless otherwise specified. | ||||||
11 | "Executive Director" means the Executive Director of the | ||||||
12 | Illinois Health Benefits Exchange. | ||||||
13 | "Federal Act" means the federal Patient Protection and | ||||||
14 | Affordable Care Act (Public Law 111-148), as amended by the | ||||||
15 | federal Health Care and Education Reconciliation Act of 2010 | ||||||
16 | (Public Law 111-152), and any amendments thereto, or | ||||||
17 | regulations or guidance issued under, those Acts. | ||||||
18 | "Health benefit plan" means a policy, contract, | ||||||
19 | certificate, or agreement offered or issued by a health carrier | ||||||
20 | to provide, deliver, arrange for, pay for, or reimburse any of | ||||||
21 | the costs of health care services.
"Health benefit plan" does | ||||||
22 | not include: | ||||||
23 | (1) coverage for accident only or disability income | ||||||
24 | insurance or any combination thereof; | ||||||
25 | (2) coverage issued as a supplement to liability | ||||||
26 | insurance; |
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1 | (3) liability insurance, including general liability | ||||||
2 | insurance and automobile liability insurance; | ||||||
3 | (4) workers' compensation or similar insurance; | ||||||
4 | (5) automobile medical payment insurance; | ||||||
5 | (6) credit-only insurance; | ||||||
6 | (7) coverage for on-site medical clinics; or | ||||||
7 | (8) other similar insurance coverage, specified in | ||||||
8 | federal regulations issued pursuant to the federal Health | ||||||
9 | Information Portability and Accountability Act of 1996, | ||||||
10 | Public Law 104-191, under which benefits for health care | ||||||
11 | services are secondary or incidental to other insurance | ||||||
12 | benefits. | ||||||
13 | "Health benefit plan" does not include the following | ||||||
14 | benefits if they are provided under a separate policy, | ||||||
15 | certificate, or contract of insurance or are otherwise not an | ||||||
16 | integral part of the plan: | ||||||
17 | (a) limited scope dental or vision benefits; | ||||||
18 | (b) benefits for long-term care, nursing home care, | ||||||
19 | home health care, community-based care, or any combination | ||||||
20 | thereof; or | ||||||
21 | (c) other similar, limited benefits specified in | ||||||
22 | federal regulations issued pursuant to Public Law 104-191. | ||||||
23 | "Health benefit plan" does not include the following | ||||||
24 | benefits if the benefits are provided under a separate policy, | ||||||
25 | certificate, or contract of insurance, there is no coordination | ||||||
26 | between the provision of the benefits and any exclusion of |
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1 | benefits under any group health plan maintained by the same | ||||||
2 | plan sponsor, and the benefits are paid with respect to an | ||||||
3 | event without regard to whether benefits are provided with | ||||||
4 | respect to such an event under any group health plan maintained | ||||||
5 | by the same plan sponsor: | ||||||
6 | (i) coverage only for a specified disease or illness; | ||||||
7 | or | ||||||
8 | (ii) hospital indemnity or other fixed indemnity | ||||||
9 | insurance. | ||||||
10 | "Health benefit plan" does not include the following if | ||||||
11 | offered as a separate policy, certificate, or contract of | ||||||
12 | insurance: | ||||||
13 | (A) Medicare supplemental health insurance as defined | ||||||
14 | under Section 1882(g)(1) of the federal Social Security | ||||||
15 | Act; | ||||||
16 | (B) coverage supplemental to the coverage provided | ||||||
17 | under Chapter 55 of Title 10, United States Code (Civilian | ||||||
18 | Health and Medical Program of the Uniformed Services | ||||||
19 | (CHAMPUS)); or | ||||||
20 | (C) similar supplemental coverage provided to coverage | ||||||
21 | under a group health plan. | ||||||
22 | "Health benefit plan" does not include a group health plan | ||||||
23 | or multiple employer welfare arrangement to the extent the plan | ||||||
24 | or arrangement is not subject to State insurance regulation | ||||||
25 | under Section 514 of the federal Employee Retirement Income | ||||||
26 | Security Act of 1974. |
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1 | "Health insurance carrier" or "carrier" means an entity | ||||||
2 | subject to the insurance laws and regulations of this State, or | ||||||
3 | subject to the jurisdiction of the Director, that contracts or | ||||||
4 | offers to contract to provide, deliver, arrange for, pay for, | ||||||
5 | or reimburse any of the costs of health care services, | ||||||
6 | including a sickness and accident insurance company, a health | ||||||
7 | maintenance organization, or any other entity providing a plan | ||||||
8 | of health insurance, or health benefits. "Health insurance | ||||||
9 | carrier" does not include short term, accident only, disability | ||||||
10 | income, hospital confinement or fixed indemnity, vision only, | ||||||
11 | limited benefit, or credit insurance, coverage issued as a | ||||||
12 | supplement to liability insurance, insurance arising out of a | ||||||
13 | workers' compensation or similar law, automobile | ||||||
14 | medical-payment insurance, insurance under which benefits are | ||||||
15 | payable with or without regard to fault and which is | ||||||
16 | statutorily required to be contained in any liability insurance | ||||||
17 | policy or equivalent self-insurance, or a Consumer Operated and | ||||||
18 | Oriented Plan. | ||||||
19 | "Illinois Health Benefits Exchange Fund" means the fund | ||||||
20 | created outside of the State treasury to be used exclusively to | ||||||
21 | provide funding for the operation and administration of the | ||||||
22 | Exchange in carrying out the purposes authorized by this Law. | ||||||
23 | "Individual Exchange" means the exchange marketplace | ||||||
24 | established by this Law through which qualified individuals may | ||||||
25 | obtain coverage through an individual market qualified health | ||||||
26 | plan. |
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1 | "Principal place of business" means the location in a state | ||||||
2 | where an employer has its headquarters or significant place of | ||||||
3 | business and where the persons with direction and control | ||||||
4 | authority over the business are employed. | ||||||
5 | "Qualified dental plan" means a limited scope dental plan | ||||||
6 | that has been certified in accordance with this Law. | ||||||
7 | "Qualified employee" means an eligible individual employed | ||||||
8 | by a qualified employer who has been offered health insurance | ||||||
9 | coverage by that qualified employer through the SHOP on the | ||||||
10 | Exchange. | ||||||
11 | "Qualified employer" means a small employer that elects to | ||||||
12 | make its full-time employees eligible for one or more qualified | ||||||
13 | health plans or qualified dental plans offered through the SHOP | ||||||
14 | Exchange, and at the option of the employer, some or all of its | ||||||
15 | part-time employees, provided that the employer has its | ||||||
16 | principal place of business in this State and elects to provide | ||||||
17 | coverage through the SHOP Exchange to all of its eligible | ||||||
18 | employees, wherever employed. | ||||||
19 | "Qualified health plan" or "QHP" means a health benefit | ||||||
20 | plan that has in effect a certification that the plan meets the | ||||||
21 | criteria for certification described in Section 1311(c) of the | ||||||
22 | Federal Act. | ||||||
23 | "Qualified health plan issuer" or "QHP issuer" means a | ||||||
24 | health insurance issuer that offers a health plan that the | ||||||
25 | Exchange has certified as a qualified health plan. | ||||||
26 | "Qualified individual" means an individual, including a |
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1 | minor, who: | ||||||
2 | (1) is seeking to enroll in a qualified health plan or | ||||||
3 | qualified dental plan offered to individuals through the | ||||||
4 | Exchange; | ||||||
5 | (2) resides in this State; | ||||||
6 | (3) at the time of enrollment, is not incarcerated, | ||||||
7 | other than incarceration pending the disposition of | ||||||
8 | charges; and | ||||||
9 | (4) is, and is reasonably expected to be, for the | ||||||
10 | entire period for which enrollment is sought, a citizen or | ||||||
11 | national of the United States or an alien lawfully present | ||||||
12 | in the United States. | ||||||
13 | "Secretary" means the Secretary of the federal Department | ||||||
14 | of Health and Human Services. | ||||||
15 | "SHOP Exchange" means the Small Business Health Options | ||||||
16 | Program established under this Law through which a qualified | ||||||
17 | employer can provide small group qualified health plans to its | ||||||
18 | qualified employees through various options available to the | ||||||
19 | employer, including, but not limited to: (a) offering one | ||||||
20 | qualified health plan to employees, (b) offering multiple | ||||||
21 | qualified health plans to employees, or (c) offering an | ||||||
22 | employee-directed choice of a qualified health plan within an | ||||||
23 | employer-selected coverage tier. | ||||||
24 | "Small employer" means, in connection with a group health | ||||||
25 | plan with respect to a calendar year and a plan year, an | ||||||
26 | employer who employed an average of at least 2 but not more |
| |||||||
| |||||||
1 | than 50 employees before January 1, 2016 and no more than 100 | ||||||
2 | employees on and after January 1, 2016 on business days during | ||||||
3 | the preceding calendar year and who employs at least one | ||||||
4 | employee on the first day of the plan year.
For purposes of | ||||||
5 | this definition: | ||||||
6 | (a) all persons treated as a single employer under | ||||||
7 | subsection (b), (c), (m) or (o) of Section 414 of the | ||||||
8 | federal Internal Revenue Code of 1986 shall be treated as a | ||||||
9 | single employer; | ||||||
10 | (b) an employer and any predecessor employer shall be | ||||||
11 | treated as a single employer; | ||||||
12 | (c) employees shall be counted in accordance with | ||||||
13 | federal law and regulations and State law and regulations; | ||||||
14 | provided however, that in the event of a conflict between | ||||||
15 | the federal law and regulations and the State law and | ||||||
16 | regulations, the federal law and regulations shall | ||||||
17 | prevail; | ||||||
18 | (d) if an employer was not in existence throughout the | ||||||
19 | preceding calendar year, then the determination of whether | ||||||
20 | that employer is a small employer shall be based on the | ||||||
21 | average number of employees that is reasonably expected | ||||||
22 | that employer will employ on business days in the current | ||||||
23 | calendar year; and | ||||||
24 | (e) an employer that makes enrollment in qualified | ||||||
25 | health plans or qualified dental plans available to its | ||||||
26 | employees through the SHOP Exchange, and would cease to be |
| |||||||
| |||||||
1 | a small employer by reason of an increase in the number of | ||||||
2 | its employees, shall continue to be treated as a small | ||||||
3 | employer for purposes of this Law as long as it | ||||||
4 | continuously makes enrollment through the SHOP Exchange | ||||||
5 | available to its employees. | ||||||
6 | (215 ILCS 122/5-5)
| ||||||
7 | Sec. 5-5. Establishment of the Exchange State health | ||||||
8 | benefits exchange . | ||||||
9 | (a) It is declared that this State, beginning on the | ||||||
10 | effective date of this amendatory Act of the 98th General | ||||||
11 | Assembly October 1, 2013 , in accordance with Section 1311 of | ||||||
12 | the federal Patient Protection and Affordable Care Act, shall | ||||||
13 | establish a State health benefits exchange to be known as the | ||||||
14 | Illinois Health Benefits Exchange in order to help individuals | ||||||
15 | and small employers with no more than 50 employees shop for, | ||||||
16 | select, and enroll in qualified, affordable private health | ||||||
17 | plans that fit their needs at competitive prices. The Exchange | ||||||
18 | shall separate coverage pools for individuals and small | ||||||
19 | employers and shall supplement and not supplant any existing | ||||||
20 | private health insurance market for individuals and small | ||||||
21 | employers. These health plans shall be available to individuals | ||||||
22 | and small employers for enrollment by October 1, 2014.
| ||||||
23 | (b) There is hereby created a political subdivision, body | ||||||
24 | politic and corporate, named the Illinois Health Benefits | ||||||
25 | Exchange. The Exchange shall be a public entity, but shall not |
| |||||||
| |||||||
1 | be considered a department, institution, or agency of the | ||||||
2 | State. | ||||||
3 | (c) The Exchange shall be comprised of an individual and a | ||||||
4 | small business health options (SHOP) exchange. Pursuant to | ||||||
5 | Section 1311(b)(2) of the Federal Act, the Exchange shall | ||||||
6 | provide individual exchange services to qualified individuals | ||||||
7 | and SHOP Exchange services to qualified employers under a | ||||||
8 | single governance and administrative structure. The Board | ||||||
9 | shall produce an assessment, which must include a premium | ||||||
10 | impact study, by July 1, 2016 to determine the viability of | ||||||
11 | merging the SHOP Exchange and Individual Exchange functions | ||||||
12 | into a single exchange by January 1, 2017. Any recommended | ||||||
13 | merger of the SHOP Exchange and Individual Exchange functions | ||||||
14 | shall be subject to legislative approval. | ||||||
15 | (d) The Exchange shall promote a competitive marketplace | ||||||
16 | for consumer access to affordable health coverage options. The | ||||||
17 | Department shall review and recommend that the Board certify | ||||||
18 | health benefit plans on the individual and SHOP Exchange, as | ||||||
19 | applicable, provided that any such health benefit plan meets | ||||||
20 | the requirements set forth in Section 1311(c) of the Federal | ||||||
21 | Act and any other requirements of the Illinois Insurance Code. | ||||||
22 | The Board shall certify health benefit plans that the | ||||||
23 | Department recommends for certification. | ||||||
24 | (e) The Exchange shall not supersede the provisions of the | ||||||
25 | Illinois Insurance Code, nor the functions of the Department of | ||||||
26 | Insurance, the Department of Healthcare and Family Services, or |
| |||||||
| |||||||
1 | the Department of Public Health. | ||||||
2 | (Source: P.A. 97-142, eff. 7-14-11.) | ||||||
3 | (215 ILCS 122/5-6 new) | ||||||
4 | Sec. 5-6. Health benefit plan certification. | ||||||
5 | (a) To be certified as a qualified health plan, a health | ||||||
6 | benefit plan shall, at a minimum: | ||||||
7 | (1) provide the essential health benefits package | ||||||
8 | described in Section 1302(a) of
the Federal Act; except | ||||||
9 | that the plan is not required to provide essential benefits | ||||||
10 | that duplicate
the minimum benefits of qualified dental | ||||||
11 | plans, as provided in subsection (e) of this Section if: | ||||||
12 | (A) the Board, in cooperation with the Department, | ||||||
13 | has determined that at least one qualified dental plan | ||||||
14 | is
available to supplement the plan's coverage; and | ||||||
15 | (B) the health carrier makes prominent disclosure | ||||||
16 | at the time it offers the
plan, in a form approved by | ||||||
17 | the Board, that the plan does not provide the full | ||||||
18 | range of
essential pediatric dental benefits and that | ||||||
19 | qualified dental plans providing those benefits and
| ||||||
20 | other dental benefits not covered by the plan are | ||||||
21 | offered through the Exchange; | ||||||
22 | (2) fulfill all premium rate and contract filing | ||||||
23 | requirements and ensure that no contract language has been | ||||||
24 | disapproved by the Director; | ||||||
25 | (3) provide at least the minimum level of coverage |
| |||||||
| |||||||
1 | prescribed by the Federal Act; | ||||||
2 | (4) ensure that the cost-sharing requirements of the | ||||||
3 | plan do not exceed the limits
established under Section | ||||||
4 | 1302(c)(l) of the Federal Act, and if the plan is offered | ||||||
5 | through the
SHOP Exchange, the plan's deductible does not | ||||||
6 | exceed the limits established under Section
1302(c)(2) of | ||||||
7 | the Federal Act; | ||||||
8 | (5) be offered by a health carrier that: | ||||||
9 | (A) is authorized and in good standing to offer | ||||||
10 | health insurance coverage; | ||||||
11 | (B) offers at least one qualified health plan at | ||||||
12 | the silver level and at
least one plan at the gold | ||||||
13 | level, as described in the Federal Act, through each | ||||||
14 | component of the Board in which the health
carrier | ||||||
15 | participates; for the purposes of this subparagraph | ||||||
16 | (B), "component"
means the SHOP Exchange and the | ||||||
17 | exchange for individual coverage within the American
| ||||||
18 | Health Benefit Exchange; | ||||||
19 | (C) charges the same premium rate for each | ||||||
20 | qualified health plan without
regard to whether the | ||||||
21 | plan is offered through the Exchange and without regard | ||||||
22 | to whether the
plan is offered directly from the health | ||||||
23 | carrier or through an insurance producer; | ||||||
24 | (D) does not charge any cancellation fees or | ||||||
25 | penalties; and | ||||||
26 | (E) complies with the regulations established by |
| |||||||
| |||||||
1 | the Secretary under
Section 1311 (d) of the Federal Act | ||||||
2 | and any other requirements of the Illinois Insurance | ||||||
3 | Code and the Department; | ||||||
4 | (6) meet the requirements of certification pursuant to | ||||||
5 | the requirements of the Department and the Illinois | ||||||
6 | Insurance Code provided in
this Law and the requirements | ||||||
7 | issued by the Secretary under Section 1311(c) of the | ||||||
8 | Federal Act and rules promulgated or adopted
pursuant to | ||||||
9 | this Law or the Federal Act, which shall include: | ||||||
10 | (A) minimum standards in the areas of marketing | ||||||
11 | practices; | ||||||
12 | (B) network adequacy; | ||||||
13 | (C) essential community providers in underserved | ||||||
14 | areas; | ||||||
15 | (D) accreditation; | ||||||
16 | (E) quality improvement; | ||||||
17 | (F) uniform enrollment forms and descriptions of | ||||||
18 | coverage; and | ||||||
19 | (G) information on quality measures for health | ||||||
20 | benefit plan performance; and | ||||||
21 | (7) include outpatient clinics in the health plan's | ||||||
22 | region that are controlled by an entity that also controls | ||||||
23 | a 340B eligible provider as defined by Section 340B(a)(4) | ||||||
24 | of the federal Public Health Service Act such that the | ||||||
25 | outpatient clinics are subject to the same mission, | ||||||
26 | policies, and medical standards related to the provision of |
| |||||||
| |||||||
1 | health care services as the 340B eligible provider. | ||||||
2 | (b) The Department shall require each health carrier | ||||||
3 | seeking certification of a plan as a
qualified health plan to: | ||||||
4 | (1) make available to the public, in plain language as | ||||||
5 | defined in Section 1311(e)(3)(B) of the Federal Act, and | ||||||
6 | submit to the Board, the Secretary, and the Department | ||||||
7 | accurate
and timely disclosure of the following: | ||||||
8 | (i) claims payment policies and practices; | ||||||
9 | (ii) periodic financial disclosures; | ||||||
10 | (iii) data on enrollment; | ||||||
11 | (iv) data on disenrollment; | ||||||
12 | (v) data on the number of claims that are | ||||||
13 | denied; | ||||||
14 | (vi) data on rating practices; | ||||||
15 | (vii) information on cost-sharing and payments | ||||||
16 | with respect to any
out-of-network coverage; | ||||||
17 | (viii) information on enrollee and participant | ||||||
18 | rights under Title I of
the Federal Act; and | ||||||
19 | (ix) other information as determined | ||||||
20 | appropriate by the Secretary, including, but not | ||||||
21 | limited to, accredited clinical quality measures; | ||||||
22 | and | ||||||
23 | (2) permit individuals to learn, in a timely manner | ||||||
24 | upon the request of the
individual, the comparative quality | ||||||
25 | standards of the plans along established clinical | ||||||
26 | data-based standards and the amount of cost-sharing, |
| |||||||
| |||||||
1 | including deductibles, copayments, and coinsurance,
under | ||||||
2 | the individual's plan or coverage that the individual would | ||||||
3 | be responsible for paying with
respect to the furnishing of | ||||||
4 | a specific item or service by a participating provider and | ||||||
5 | make this
information available to the individual through | ||||||
6 | an Internet website that is publicly accessible and
through | ||||||
7 | other means for individuals without access to the Internet. | ||||||
8 | (c) The Department shall not exempt any health carrier | ||||||
9 | seeking certification as a qualified
health plan, regardless of | ||||||
10 | the type or size of the health carrier, from licensure or | ||||||
11 | solvency
requirements and shall apply the criteria of this | ||||||
12 | Section in a manner that ensures a level playing
field between | ||||||
13 | or among health carriers participating in the Exchange. | ||||||
14 | (d) The provisions of this Law that are applicable to | ||||||
15 | qualified health plans shall also
apply, to the extent | ||||||
16 | relevant, to qualified dental plans, except as modified in | ||||||
17 | accordance with the
provisions of paragraphs (1), (2), and (3) | ||||||
18 | of this subsection (d) or by rules adopted by the
Board. | ||||||
19 | (1) The health carrier shall be licensed to offer | ||||||
20 | dental coverage, but need not be
licensed to offer other | ||||||
21 | health benefits. | ||||||
22 | (2) The plan shall be limited to dental and oral health | ||||||
23 | benefits, without
substantially duplicating the benefits | ||||||
24 | typically offered by health benefit plans without dental
| ||||||
25 | coverage and shall include, at a minimum, the essential | ||||||
26 | pediatric dental benefits prescribed by
the Secretary |
| |||||||
| |||||||
1 | pursuant to Section 1302(b)(l)(J) of the Federal Act and | ||||||
2 | such other dental benefits
as the Board or the Secretary | ||||||
3 | may specify by rule. | ||||||
4 | (3) Health carriers may jointly offer a comprehensive | ||||||
5 | plan through the Exchange
in which the dental benefits are | ||||||
6 | provided by a health carrier through a qualified dental | ||||||
7 | plan and
the other benefits are provided by a health | ||||||
8 | carrier through a qualified health plan, provided that
the | ||||||
9 | plans are priced separately and are also made available for | ||||||
10 | purchase separately at the same
price. | ||||||
11 | (215 ILCS 122/5-15)
| ||||||
12 | Sec. 5-15. Illinois Health Benefits Exchange Legislative | ||||||
13 | Oversight Study Committee. | ||||||
14 | (a) There is created an Illinois Health Benefits Exchange | ||||||
15 | Legislative Oversight Study Committee within the Commission on | ||||||
16 | Government Forecasting and Accountability to provide | ||||||
17 | accountability for conduct a study regarding State | ||||||
18 | implementation and establishment of the Illinois Health | ||||||
19 | Benefits Exchange and to ensure Exchange operations and | ||||||
20 | functions align with the goals and duties outlined by this Law . | ||||||
21 | The Committee shall also be responsible for providing policy | ||||||
22 | recommendations to ensure the Exchange aligns with the Federal | ||||||
23 | Act, amendments to the Federal Act, and regulations promulgated | ||||||
24 | pursuant to the Federal Act. | ||||||
25 | (b) Members of the Legislative Oversight Study Committee |
| |||||||
| |||||||
1 | shall be appointed as follows: 3 members of the Senate shall be | ||||||
2 | appointed by the President of the Senate; 3 members of the | ||||||
3 | Senate shall be appointed by the Minority Leader of the Senate; | ||||||
4 | 3 members of the House of Representatives shall be appointed by | ||||||
5 | the Speaker of the House of Representatives; and 3 members of | ||||||
6 | the House of Representatives shall be appointed by the Minority | ||||||
7 | Leader of the House of Representatives. Each legislative leader | ||||||
8 | shall select one member to serve as co-chair of the committee. | ||||||
9 | (c) Members of the Legislative Oversight Study Committee | ||||||
10 | shall be appointed no later than June 1, 2013 within 30 days | ||||||
11 | after the effective date of this Law. The co-chairs shall | ||||||
12 | convene the first meeting of the committee no later than 45 | ||||||
13 | days after the effective date of this Law .
| ||||||
14 | (Source: P.A. 97-142, eff. 7-14-11.) | ||||||
15 | (215 ILCS 122/5-16 new) | ||||||
16 | Sec. 5-16. Exchange governance. The governing and | ||||||
17 | administrative powers of the Exchange shall be vested in a body | ||||||
18 | known as the Illinois Health Benefits Exchange Board. The | ||||||
19 | following provisions shall apply: | ||||||
20 | (1) The Board shall consist of 11 voting members | ||||||
21 | appointed by the Governor with the advice and consent of a | ||||||
22 | majority of the members elected to the Senate. In addition, | ||||||
23 | the Director of Healthcare and Family Services, and the | ||||||
24 | Executive Director of the Exchange shall serve as | ||||||
25 | non-voting, ex-officio members of the Board. The Governor |
| |||||||
| |||||||
1 | shall also appoint as non-voting, ex-officio members one | ||||||
2 | economist with experience in the health care markets and | ||||||
3 | one educated health care consumer advocate. All Board | ||||||
4 | members shall be appointed no later than January 1, 2014. | ||||||
5 | (2) The Governor shall make the appointments so as to | ||||||
6 | reflect no less than proportional representation of the | ||||||
7 | geographic, gender, cultural, racial, and ethnic | ||||||
8 | composition of this State and in accordance with | ||||||
9 | subparagraphs (A), (B), and (C) of this paragraph, as | ||||||
10 | follows: | ||||||
11 | (A) No more than 4 voting members may represent the | ||||||
12 | following interests, of which no more than 2 may | ||||||
13 | represent any one interest: | ||||||
14 | (1) the insurance industry; | ||||||
15 | (2) health care administrators; and | ||||||
16 | (3) licensed health care professionals. | ||||||
17 | (B) At least 7 voting members shall represent the | ||||||
18 | following interest groups, with each interest group | ||||||
19 | represented by at least one voting member: | ||||||
20 | (1) a labor interest group; | ||||||
21 | (2) a women's interest group; | ||||||
22 | (3) a minorities' interest group; | ||||||
23 | (4) a disabled persons' interest group; | ||||||
24 | (5) a small business interest group; and | ||||||
25 | (6) a public health interest group. | ||||||
26 | (C) Each person appointed to the Board should have |
| |||||||
| |||||||
1 | demonstrated experience in at least one of the | ||||||
2 | following areas: | ||||||
3 | (1) individual health insurance coverage; | ||||||
4 | (2) small employer health insurance; | ||||||
5 | (3) health benefits administration; | ||||||
6 | (4) health care finance; | ||||||
7 | (5) administration of a public or private | ||||||
8 | health care delivery system; | ||||||
9 | (6) the provision of health care services; | ||||||
10 | (7) the purchase of health insurance coverage; | ||||||
11 | (8) health care consumer navigation or | ||||||
12 | assistance; | ||||||
13 | (9) health care economics or health care | ||||||
14 | actuarial sciences; | ||||||
15 | (10) information technology; or | ||||||
16 | (11) starting a small business with 50 or fewer | ||||||
17 | employees. | ||||||
18 | (3) The Board shall elect one voting member of the | ||||||
19 | Board to serve as chairperson and one voting member to | ||||||
20 | serve as vice-chairperson, upon approval of a majority of | ||||||
21 | the Board. | ||||||
22 | (4) The Exchange shall be administered by an Executive | ||||||
23 | Director, who shall be appointed, and may be removed, by a | ||||||
24 | majority of the Board. The Board shall have the power to | ||||||
25 | determine compensation for the Executive Director. | ||||||
26 | (5) The terms of the non-voting, ex-officio members of |
| |||||||
| |||||||
1 | the Board shall run concurrent with their terms of | ||||||
2 | appointment to office, or in the case of the Executive | ||||||
3 | Director, his or her term of appointment to that position, | ||||||
4 | subject to the determination of the Board. The terms of the | ||||||
5 | members, including those non-voting, ex-officio members | ||||||
6 | appointed by the Governor, shall be 4 years. Upon | ||||||
7 | conclusion of the initial term, the next term and every | ||||||
8 | term subsequent to it shall run for 3 years. Voting members | ||||||
9 | shall serve no more than 3 consecutive terms. | ||||||
10 | A person appointed to fill a vacancy and complete the | ||||||
11 | unexpired term of a member of the Board shall only be | ||||||
12 | appointed to serve out the unexpired term by the individual | ||||||
13 | who made the original appointment within 45 days after the | ||||||
14 | initial vacancy. A person appointed to fill a vacancy and | ||||||
15 | complete the unexpired term of a member of the Board may be | ||||||
16 | re-appointed to the Board for another term, but shall not | ||||||
17 | serve than more than 2 consecutive terms following their | ||||||
18 | completion of the unexpired term of a member of the Board. | ||||||
19 | If a voting Board member's qualifications change due to | ||||||
20 | a change in employment during the term of their | ||||||
21 | appointment, then the Board member shall resign their | ||||||
22 | position, subject to reappointment by the individual who | ||||||
23 | made the original appointment. | ||||||
24 | (6) The Board shall, as necessary, create and appoint | ||||||
25 | qualified persons with requisite expertise to Exchange | ||||||
26 | technical advisory groups. These Exchange technical |
| |||||||
| |||||||
1 | advisory groups shall meet in a manner and frequency | ||||||
2 | determined by the Board to discuss exchange-related issues | ||||||
3 | and to provide exchange-related guidance, advice, and | ||||||
4 | recommendations to the Board and the Exchange. There shall | ||||||
5 | be at a minimum, 6 technical advisory groups, including the | ||||||
6 | following: | ||||||
7 | (1) an insurer advisory group; | ||||||
8 | (2) a business advisory group; | ||||||
9 | (3) a consumer advisory group; | ||||||
10 | (4) a provider advisory group; | ||||||
11 | (5) an insurance producer advisory group; and | ||||||
12 | (6) a dentist advisory group. | ||||||
13 | (7) The Board shall meet no less than quarterly on a | ||||||
14 | schedule established by the chairperson. Meetings shall be | ||||||
15 | public and public records shall be maintained, subject to | ||||||
16 | the Open Meetings Act. A majority of the Board shall | ||||||
17 | constitute a quorum and the affirmative vote of a majority | ||||||
18 | is necessary for any action of the Board. No vacancy shall | ||||||
19 | impair the ability of the Board to act provided a quorum is | ||||||
20 | reached. Members shall serve without pay, but shall be | ||||||
21 | reimbursed for their actual and reasonable expenses | ||||||
22 | incurred in the performance of their duties. The | ||||||
23 | chairperson of the Board shall file a written report | ||||||
24 | regarding the activities of the Board and the Exchange to | ||||||
25 | the Governor and General Assembly annually, and the | ||||||
26 | Legislative Oversight Committee established in Section |
| |||||||
| |||||||
1 | 5-15 quarterly, beginning on September 1, 2013 through | ||||||
2 | December 31, 2014. | ||||||
3 | (8) The Board shall adopt conflict of interest rules | ||||||
4 | and recusal procedures. Such rules and procedures shall (i) | ||||||
5 | prohibit a member of the Board from performing an official | ||||||
6 | act that may have a direct economic benefit on a business | ||||||
7 | or other endeavor in which that member has a direct or | ||||||
8 | substantial financial interest and (ii) require a member of | ||||||
9 | the Board to recuse himself or herself from an official | ||||||
10 | matter, whether direct or indirect. All recusals must be in | ||||||
11 | writing and specify the reason and date of the recusal. All | ||||||
12 | recusals shall be maintained by the Executive Director and | ||||||
13 | shall be disclosed to any person upon written request. | ||||||
14 | (9) The Board shall develop a budget, to be submitted | ||||||
15 | to the General Assembly along with the Governor's annual | ||||||
16 | budget proposal and approved by the General Assembly, for | ||||||
17 | the implementation and operation of the Exchange for | ||||||
18 | operating expenses, including, but not limited to: | ||||||
19 | (A) proposed compensation levels for the Executive | ||||||
20 | Director and shall identify personnel and staffing | ||||||
21 | needs for the implementation and operation of the | ||||||
22 | Exchange; | ||||||
23 | (B) disclosure of funds received or expected to be | ||||||
24 | received from the federal government for the | ||||||
25 | infrastructure and systems of the Exchange and those | ||||||
26 | funds received or expected to be received for program |
| |||||||
| |||||||
1 | administration and operations; | ||||||
2 | (C) delineation of those functions of the Exchange | ||||||
3 | that are to be paid by State and federal programs that | ||||||
4 | are allocable to the State's General Revenue Fund; and | ||||||
5 | (D) beginning January 1, 2015, insurer assessments | ||||||
6 | contingent upon the use of federal funds for the first | ||||||
7 | year of operation of the Exchange and upon the review | ||||||
8 | and recommendations of the Commission on Government | ||||||
9 | Forecasting and Accountability. | ||||||
10 | (10) The Board shall, in consultation with the Health | ||||||
11 | Benefits Exchange Legislative Oversight Committee, produce | ||||||
12 | a cost-benefit analysis of the State's essential health | ||||||
13 | benefits no later than August 1, 2015 for the purposes of | ||||||
14 | informing the U.S. Department of Health and Human Services | ||||||
15 | in their re-evaluation of the essential health benefits for | ||||||
16 | plan years 2016 and beyond. | ||||||
17 | (11) The purpose of the Board shall be to implement the | ||||||
18 | Exchange in accordance with this Section and shall be | ||||||
19 | authorized to establish procedures for the operation of the | ||||||
20 | Exchange, subject to legislative approval. | ||||||
21 | (215 ILCS 122/5-17 new) | ||||||
22 | Sec. 5-17. Insurer's assessment. Every carrier licensed to | ||||||
23 | issue, and that issues for delivery, policies of accident and | ||||||
24 | health insurance in this State shall be assessed. An insurer's | ||||||
25 | assessment shall be determined by multiplying the total |
| |||||||
| |||||||
1 | assessment, as determined in this Section, by a fraction, the | ||||||
2 | numerator of which equals that insurer's direct Illinois | ||||||
3 | premiums, excluding those premiums from limited lines policies | ||||||
4 | and supplemental insurance policies, during the preceding | ||||||
5 | calendar year and the denominator of which equals the total of | ||||||
6 | all insurers' direct Illinois premiums, excluding those | ||||||
7 | premiums from limited lines policies and supplemental | ||||||
8 | insurance policies. The Board may exempt those insurers whose | ||||||
9 | share as determined under this Section would be so minimal as | ||||||
10 | to not exceed the estimated cost of levying the assessment. The | ||||||
11 | Board shall charge and collect from each insurer the amounts | ||||||
12 | determined to be due under this Section. The assessment shall | ||||||
13 | be billed by Board invoice based upon the insurer's direct | ||||||
14 | Illinois premium income, excluding premium income from limited | ||||||
15 | lines policies and supplemental insurance policies, as shown in | ||||||
16 | its annual statement for the preceding calendar year as filed | ||||||
17 | with the Director. The invoice shall be due upon receipt and | ||||||
18 | must be paid no later than 30 days after receipt by the | ||||||
19 | insurer. | ||||||
20 | When a carrier fails to pay the full amount of any | ||||||
21 | assessment of $100 or more due under this Section there shall | ||||||
22 | be added to the amount due as a penalty the greater of $50 or an | ||||||
23 | amount equal to 5% of the deficiency for each month or part of | ||||||
24 | a month that the deficiency remains unpaid. All moneys | ||||||
25 | collected by the Board shall be placed in the Illinois Health | ||||||
26 | Benefits Exchange Fund. |
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1 | Insurers shall be assessed only an amount not exceeding the | ||||||
2 | General Assembly's approved Board budget. No assessment shall | ||||||
3 | be made on insurers while assessments are being made pursuant | ||||||
4 | to Section 12 of the Comprehensive Health Insurance Plan Act. | ||||||
5 | The assessment shall also take into consideration any unspent | ||||||
6 | federal funds remaining and shall be reduced accordingly. | ||||||
7 | The Board shall prepare annually a complete and detailed | ||||||
8 | written report accounting for all funds received and dispensed | ||||||
9 | during the preceding fiscal year. | ||||||
10 | (215 ILCS 122/5-18 new) | ||||||
11 | Sec. 5-18. Illinois Health Benefits Exchange Fund. There | ||||||
12 | is hereby created as a fund outside of the State treasury the | ||||||
13 | Illinois Health Benefits Exchange Fund to be used, subject to | ||||||
14 | appropriation, exclusively by the Exchange to provide funding | ||||||
15 | for the operation and administration of the Exchange in | ||||||
16 | carrying out the purposes authorized in this Law. | ||||||
17 | (215 ILCS 122/5-21 new) | ||||||
18 | Sec. 5-21. Enrollment through brokers and agents; producer | ||||||
19 | compensation. | ||||||
20 | (a) In accordance with Section 1312(e) of the Federal Act, | ||||||
21 | the Exchange shall allow licensed insurance producers to (1) | ||||||
22 | enroll qualified individuals in any qualified health plan, for | ||||||
23 | which the individual is eligible, in the individual exchange, | ||||||
24 | (2) assist qualified individuals in applying for premium tax |
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1 | credits and cost-sharing reductions for qualified health plans | ||||||
2 | purchased through the individual exchange, and (3) enroll | ||||||
3 | qualified employers in any qualified health plan, for which the | ||||||
4 | employer is eligible, offered through the SHOP exchange. | ||||||
5 | Nothing in this subsection (a) shall be construed as to require | ||||||
6 | a qualified individual or qualified employer to utilize a | ||||||
7 | licensed insurance producer for any of the purposes outlined in | ||||||
8 | this subsection (a). | ||||||
9 | (b) In order to enroll individuals and small employers in | ||||||
10 | qualified health plans on the Exchange, licensed producers must | ||||||
11 | complete a certification program. The Department of Insurance | ||||||
12 | may develop and implement a certification program for licensed | ||||||
13 | insurance producers who enroll individuals and employers in the | ||||||
14 | exchange. The Department of Insurance may charge a reasonable | ||||||
15 | fee, by regulation, to producers for the certification program. | ||||||
16 | The Department of Insurance may approve certification programs | ||||||
17 | developed and instructed by others, charging a reasonable fee, | ||||||
18 | by regulation, for approval. | ||||||
19 | (c) The Exchange shall include on its Internet website a | ||||||
20 | producer locator section, featured prominently, through which | ||||||
21 | individuals and small employers can find exchange-certified | ||||||
22 | producers. | ||||||
23 | (d) The Exchange shall take no role in developing or | ||||||
24 | determining the manner or amount of compensation producers | ||||||
25 | receive from qualified health plans for individuals or | ||||||
26 | employers enrolled in health plans through the Exchange. |
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1 | (215 ILCS 122/5-23 new) | ||||||
2 | Sec. 5-23. Examination or investigation of the Exchange. | ||||||
3 | The Director shall have the ability to examine or investigate | ||||||
4 | the Exchange pursuant to his or her authority under Article | ||||||
5 | XXIV of the Illinois Insurance Code. | ||||||
6 | (215 ILCS 122/5-30 new) | ||||||
7 | Sec. 5-30. Dissolution of Comprehensive Health Insurance | ||||||
8 | Plan. | ||||||
9 | (a) Except as otherwise provided in this Section, the | ||||||
10 | insurance operations of the Comprehensive Health Insurance | ||||||
11 | Plan authorized by the Comprehensive Health Insurance Plan Act | ||||||
12 | shall cease on January 1, 2014. As used in this Section, "Plan" | ||||||
13 | means the Comprehensive Health Insurance plan. | ||||||
14 | (b) Coverage under the Plan does not apply to service | ||||||
15 | provided on or after January 1, 2014. | ||||||
16 | (c) A claim for payment under the Plan must be submitted | ||||||
17 | within 180 days after January 1, 2014 and paid within 60 days | ||||||
18 | after receipt. | ||||||
19 | (d) Any grievance shall be resolved by the Plan Board not | ||||||
20 | later than 360 days after January 1, 2014. In this Section, | ||||||
21 | "Plan Board" means the Illinois Comprehensive Health Insurance | ||||||
22 | Board. | ||||||
23 | (e) The Plan Board shall, not later than June 30, 2013, | ||||||
24 | submit to the Director of Insurance a plan of dissolution, |
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1 | which must provide for, but not be limited to, the following: | ||||||
2 | (1) Continuity of care for an individual who is covered | ||||||
3 | under the Plan and is an inpatient on January 1, 2014. | ||||||
4 | (2) A final accounting of assessments. | ||||||
5 | (3) Resolution of any net asset deficiency. | ||||||
6 | (4) Cessation of all liability of the Plan. | ||||||
7 | (5) Final dissolution of the Plan. | ||||||
8 | (f) The plan of dissolution may provide that, with the | ||||||
9 | approval of the Plan Board and the Director, a power or duty of | ||||||
10 | the association may be delegated to a person that is to perform | ||||||
11 | functions similar to the functions of the Plan. | ||||||
12 | (g) The Director shall, after notice and hearing, approve a | ||||||
13 | plan of dissolution submitted under subsection (e) of this | ||||||
14 | Section if the Director determines that the plan of dissolution | ||||||
15 | is suitable to ensure the fair, reasonable, and equitable | ||||||
16 | dissolution of the Plan and complies with subsection (e) of | ||||||
17 | this Section. If the Director does not find that the plan of | ||||||
18 | dissolution is suitable to ensure the fair, reasonable, and | ||||||
19 | equitable dissolution of the Plan, he or she may by order | ||||||
20 | require changes to the plan that cure the deficiencies | ||||||
21 | identified in his or her findings. | ||||||
22 | (h) A plan of dissolution submitted under subsection (e) of | ||||||
23 | this Section is effective upon the written approval of the | ||||||
24 | Director. | ||||||
25 | (i) An action by or against the Plan must be filed not more | ||||||
26 | than one year after January 1, 2014. |
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1 | (j) General Revenue Fund funds remaining in the Plan on the | ||||||
2 | date on which final dissolution of the Plan occurs must be | ||||||
3 | transferred back into the General Revenue Fund. | ||||||
4 | (k) Insurer assessments remaining in the Plan on the date | ||||||
5 | on which dissolution of the Plan occurs must be returned to | ||||||
6 | insurers based on subsection e of Section 12 of the | ||||||
7 | Comprehensive Health Insurance Plan Act. | ||||||
8 | (l) The Plan, or the person or entity to which the Plan | ||||||
9 | delegates powers under subsection (f) of this Section, may | ||||||
10 | implement this Section in accordance with the plan of | ||||||
11 | dissolution approved by the Director under subsection (g) of | ||||||
12 | this Section.
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13 | Section 99. Effective date. This Act takes effect upon | ||||||
14 | becoming law.".
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