Illinois General Assembly - Full Text of HB3960
Illinois General Assembly

  Bills & Resolutions  
  Compiled Statutes  
  Public Acts  
  Legislative Reports  
  IL Constitution  
  Legislative Guide  
  Legislative Glossary  

 Search By Number
 (example: HB0001)
Search Tips

Search By Keyword

Full Text of HB3960  103rd General Assembly




State of Illinois
2023 and 2024


Introduced 2/17/2023, by Rep. Lindsey LaPointe


215 ILCS 5/352  from Ch. 73, par. 964
305 ILCS 5/5-16.8

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the medical assistance program shall be subject to provisions of the Illinois Insurance Code concerning telehealth services. Makes a conforming change in the Illinois Insurance Code.

LRB103 31065 BMS 57688 b





HB3960LRB103 31065 BMS 57688 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 352 as follows:
6    (215 ILCS 5/352)  (from Ch. 73, par. 964)
7    Sec. 352. Scope of Article.
8    (a) Except as provided in subsections (b), (c), (d), and
9(e), this Article shall apply to all companies transacting in
10this State the kinds of business enumerated in clause (b) of
11Class 1 and clause (a) of Class 2 of Section 4. Nothing in this
12Article shall apply to, or in any way affect policies or
13contracts described in clause (a) of Class 1 of Section 4;
14however, this Article shall apply to policies and contracts
15which contain benefits providing reimbursement for the
16expenses of long term health care which are certified or
17ordered by a physician including but not limited to
18professional nursing care, custodial nursing care, and
19non-nursing custodial care provided in a nursing home or at a
20residence of the insured.
21    (b) (Blank).
22    (c) A policy issued and delivered in this State that
23provides coverage under that policy for certificate holders



HB3960- 2 -LRB103 31065 BMS 57688 b

1who are neither residents of nor employed in this State does
2not need to provide to those nonresident certificate holders
3who are not employed in this State the coverages or services
4mandated by this Article.
5    (d) Stop-loss insurance is exempt from all Sections of
6this Article, except this Section and Sections 353a, 354,
7357.30, and 370. For purposes of this exemption, stop-loss
8insurance is further defined as follows:
9        (1) The policy must be issued to and insure an
10    employer, trustee, or other sponsor of the plan, or the
11    plan itself, but not employees, members, or participants.
12        (2) Payments by the insurer must be made to the
13    employer, trustee, or other sponsors of the plan, or the
14    plan itself, but not to the employees, members,
15    participants, or health care providers.
16    (e) A policy issued or delivered in this State to the
17Department of Healthcare and Family Services (formerly
18Illinois Department of Public Aid) and providing coverage,
19under clause (b) of Class 1 or clause (a) of Class 2 as
20described in Section 4, to persons who are enrolled under
21Article V of the Illinois Public Aid Code or under the
22Children's Health Insurance Program Act is exempt from all
23restrictions, limitations, standards, rules, or regulations
24respecting benefits imposed by or under authority of this
25Code, except those specified by subsection (1) of Section 143,
26Section 356z.22, Section 370c, and Section 370c.1. Nothing in



HB3960- 3 -LRB103 31065 BMS 57688 b

1this subsection, however, affects the total medical services
2available to persons eligible for medical assistance under the
3Illinois Public Aid Code.
4    (f) An in-office membership care agreement provided under
5the In-Office Membership Care Act is not insurance for the
6purposes of this Code.
7(Source: P.A. 101-190, eff. 8-2-19.)
8    Section 10. The Illinois Public Aid Code is amended by
9changing Section 5-16.8 as follows:
10    (305 ILCS 5/5-16.8)
11    Sec. 5-16.8. Required health benefits. The medical
12assistance program shall (i) provide the post-mastectomy care
13benefits required to be covered by a policy of accident and
14health insurance under Section 356t and the coverage required
15under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
16356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
17356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60 of
18the Illinois Insurance Code, (ii) be subject to the provisions
19of Sections 356z.19, 356z.22, 356z.44, 356z.49, 364.01, 370c,
20and 370c.1 of the Illinois Insurance Code, and (iii) be
21subject to the provisions of subsection (d-5) of Section 10 of
22the Network Adequacy and Transparency Act.
23    The Department, by rule, shall adopt a model similar to
24the requirements of Section 356z.39 of the Illinois Insurance



HB3960- 4 -LRB103 31065 BMS 57688 b

2    On and after July 1, 2012, the Department shall reduce any
3rate of reimbursement for services or other payments or alter
4any methodologies authorized by this Code to reduce any rate
5of reimbursement for services or other payments in accordance
6with Section 5-5e.
7    To ensure full access to the benefits set forth in this
8Section, on and after January 1, 2016, the Department shall
9ensure that provider and hospital reimbursement for
10post-mastectomy care benefits required under this Section are
11no lower than the Medicare reimbursement rate.
12(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
13101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
141-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
15eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
16102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
171-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
18eff. 1-1-23; 102-1117, eff. 1-13-23.)