Full Text of SB2672 103rd General Assembly
SB2672enr 103RD GENERAL ASSEMBLY | | | SB2672 Enrolled | | LRB103 35845 RPS 65930 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 Illinois Insurance Code is amended by | 5 | | adding Section 356z.71 as follows: | 6 | | (215 ILCS 5/356z.71 new) | 7 | | Sec. 356z.71. Coverage during a generic drug shortage. | 8 | | (a) As used in this Section: | 9 | | "Eligible prescription drug" means a prescription drug | 10 | | approved under 21 U.S.C. 355(c) that is not under patent. | 11 | | "Generic drug" means a drug that is approved pursuant to | 12 | | an application referencing an eligible prescription drug that | 13 | | is submitted under subsection (j) of Section 505 of the | 14 | | Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(j). | 15 | | "Unavailable" means being listed as Currently in Shortage | 16 | | or as a Discontinuation in the United States Food and Drug | 17 | | Administration's Drug Shortages Database. "Unavailable" does | 18 | | not include being listed as a Resolved Shortage in the United | 19 | | States Food and Drug Administration's Drug Shortages Database. | 20 | | (b) If a generic drug or a therapeutic equivalent is | 21 | | unavailable due to a supply issue and dosage cannot be | 22 | | adjusted, a group or individual policy of accident and health | 23 | | insurance or a managed care plan that is amended, delivered, |
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| 1 | | issued, or renewed after January 1, 2026 shall provide | 2 | | coverage for a brand name eligible prescription drug until | 3 | | supply of the generic drug or a therapeutic equivalent is | 4 | | available. | 5 | | Section 10. The Health Maintenance Organization Act is | 6 | | amended by changing Section 5-3 as follows: | 7 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | 8 | | Sec. 5-3. Insurance Code provisions. | 9 | | (a) Health Maintenance Organizations shall be subject to | 10 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 11 | | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | 12 | | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | 13 | | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, | 14 | | 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | 15 | | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | 16 | | 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, | 17 | | 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, | 18 | | 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, | 19 | | 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, | 20 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, | 21 | | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, | 22 | | 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68, | 23 | | 356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, | 24 | | 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, |
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| 1 | | 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of | 2 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2, | 3 | | XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | 4 | | Illinois Insurance Code. | 5 | | (b) For purposes of the Illinois Insurance Code, except | 6 | | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | 7 | | Health Maintenance Organizations in the following categories | 8 | | are deemed to be "domestic companies": | 9 | | (1) a corporation authorized under the Dental Service | 10 | | Plan Act or the Voluntary Health Services Plans Act; | 11 | | (2) a corporation organized under the laws of this | 12 | | State; or | 13 | | (3) a corporation organized under the laws of another | 14 | | state, 30% or more of the enrollees of which are residents | 15 | | of this State, except a corporation subject to | 16 | | substantially the same requirements in its state of | 17 | | organization as is a "domestic company" under Article VIII | 18 | | 1/2 of the Illinois Insurance Code. | 19 | | (c) In considering the merger, consolidation, or other | 20 | | acquisition of control of a Health Maintenance Organization | 21 | | pursuant to Article VIII 1/2 of the Illinois Insurance Code, | 22 | | (1) the Director shall give primary consideration to | 23 | | the continuation of benefits to enrollees and the | 24 | | financial conditions of the acquired Health Maintenance | 25 | | Organization after the merger, consolidation, or other | 26 | | acquisition of control takes effect; |
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| 1 | | (2)(i) the criteria specified in subsection (1)(b) of | 2 | | Section 131.8 of the Illinois Insurance Code shall not | 3 | | apply and (ii) the Director, in making his determination | 4 | | with respect to the merger, consolidation, or other | 5 | | acquisition of control, need not take into account the | 6 | | effect on competition of the merger, consolidation, or | 7 | | other acquisition of control; | 8 | | (3) the Director shall have the power to require the | 9 | | following information: | 10 | | (A) certification by an independent actuary of the | 11 | | adequacy of the reserves of the Health Maintenance | 12 | | Organization sought to be acquired; | 13 | | (B) pro forma financial statements reflecting the | 14 | | combined balance sheets of the acquiring company and | 15 | | the Health Maintenance Organization sought to be | 16 | | acquired as of the end of the preceding year and as of | 17 | | a date 90 days prior to the acquisition, as well as pro | 18 | | forma financial statements reflecting projected | 19 | | combined operation for a period of 2 years; | 20 | | (C) a pro forma business plan detailing an | 21 | | acquiring party's plans with respect to the operation | 22 | | of the Health Maintenance Organization sought to be | 23 | | acquired for a period of not less than 3 years; and | 24 | | (D) such other information as the Director shall | 25 | | require. | 26 | | (d) The provisions of Article VIII 1/2 of the Illinois |
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| 1 | | Insurance Code and this Section 5-3 shall apply to the sale by | 2 | | any health maintenance organization of greater than 10% of its | 3 | | enrollee population (including , without limitation , the health | 4 | | maintenance organization's right, title, and interest in and | 5 | | to its health care certificates). | 6 | | (e) In considering any management contract or service | 7 | | agreement subject to Section 141.1 of the Illinois Insurance | 8 | | Code, the Director (i) shall, in addition to the criteria | 9 | | specified in Section 141.2 of the Illinois Insurance Code, | 10 | | take into account the effect of the management contract or | 11 | | service agreement on the continuation of benefits to enrollees | 12 | | and the financial condition of the health maintenance | 13 | | organization to be managed or serviced, and (ii) need not take | 14 | | into account the effect of the management contract or service | 15 | | agreement on competition. | 16 | | (f) Except for small employer groups as defined in the | 17 | | Small Employer Rating, Renewability and Portability Health | 18 | | Insurance Act and except for medicare supplement policies as | 19 | | defined in Section 363 of the Illinois Insurance Code, a | 20 | | Health Maintenance Organization may by contract agree with a | 21 | | group or other enrollment unit to effect refunds or charge | 22 | | additional premiums under the following terms and conditions: | 23 | | (i) the amount of, and other terms and conditions with | 24 | | respect to, the refund or additional premium are set forth | 25 | | in the group or enrollment unit contract agreed in advance | 26 | | of the period for which a refund is to be paid or |
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| 1 | | additional premium is to be charged (which period shall | 2 | | not be less than one year); and | 3 | | (ii) the amount of the refund or additional premium | 4 | | shall not exceed 20% of the Health Maintenance | 5 | | Organization's profitable or unprofitable experience with | 6 | | respect to the group or other enrollment unit for the | 7 | | period (and, for purposes of a refund or additional | 8 | | premium, the profitable or unprofitable experience shall | 9 | | be calculated taking into account a pro rata share of the | 10 | | Health Maintenance Organization's administrative and | 11 | | marketing expenses, but shall not include any refund to be | 12 | | made or additional premium to be paid pursuant to this | 13 | | subsection (f)). The Health Maintenance Organization and | 14 | | the group or enrollment unit may agree that the profitable | 15 | | or unprofitable experience may be calculated taking into | 16 | | account the refund period and the immediately preceding 2 | 17 | | plan years. | 18 | | The Health Maintenance Organization shall include a | 19 | | statement in the evidence of coverage issued to each enrollee | 20 | | describing the possibility of a refund or additional premium, | 21 | | and upon request of any group or enrollment unit, provide to | 22 | | the group or enrollment unit a description of the method used | 23 | | to calculate (1) the Health Maintenance Organization's | 24 | | profitable experience with respect to the group or enrollment | 25 | | unit and the resulting refund to the group or enrollment unit | 26 | | or (2) the Health Maintenance Organization's unprofitable |
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| 1 | | experience with respect to the group or enrollment unit and | 2 | | the resulting additional premium to be paid by the group or | 3 | | enrollment unit. | 4 | | In no event shall the Illinois Health Maintenance | 5 | | Organization Guaranty Association be liable to pay any | 6 | | contractual obligation of an insolvent organization to pay any | 7 | | refund authorized under this Section. | 8 | | (g) Rulemaking authority to implement Public Act 95-1045, | 9 | | if any, is conditioned on the rules being adopted in | 10 | | accordance with all provisions of the Illinois Administrative | 11 | | Procedure Act and all rules and procedures of the Joint | 12 | | Committee on Administrative Rules; any purported rule not so | 13 | | adopted, for whatever reason, is unauthorized. | 14 | | (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | 15 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 16 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | 17 | | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | 18 | | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | 19 | | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | 20 | | eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | 21 | | 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | 22 | | 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | 23 | | eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.) | 24 | | Section 15. The Limited Health Service Organization Act is | 25 | | amended by changing Section 4003 as follows: |
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| 1 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3) | 2 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 3 | | health service organizations shall be subject to the | 4 | | provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, | 5 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | 6 | | 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, | 7 | | 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, | 8 | | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | 9 | | 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | 10 | | 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71, | 11 | | 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, | 12 | | 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, | 13 | | XIII 1/2, XXV, and XXVI of the Illinois Insurance Code. | 14 | | Nothing in this Section shall require a limited health care | 15 | | plan to cover any service that is not a limited health service. | 16 | | For purposes of the Illinois Insurance Code, except for | 17 | | Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited | 18 | | health service organizations in the following categories are | 19 | | deemed to be domestic companies: | 20 | | (1) a corporation under the laws of this State; or | 21 | | (2) a corporation organized under the laws of another | 22 | | state, 30% or more of the enrollees of which are residents | 23 | | of this State, except a corporation subject to | 24 | | substantially the same requirements in its state of | 25 | | organization as is a domestic company under Article VIII |
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| 1 | | 1/2 of the Illinois Insurance Code. | 2 | | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | 3 | | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. | 4 | | 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, | 5 | | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | 6 | | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | 7 | | 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | 8 | | eff. 1-1-24; revised 8-29-23.) | 9 | | Section 20. The Voluntary Health Services Plans Act is | 10 | | amended by changing Section 10 as follows: | 11 | | (215 ILCS 165/10) (from Ch. 32, par. 604) | 12 | | Sec. 10. Application of Insurance Code provisions. Health | 13 | | services plan corporations and all persons interested therein | 14 | | or dealing therewith shall be subject to the provisions of | 15 | | Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, | 16 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | 17 | | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w, | 18 | | 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, | 19 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 20 | | 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | 21 | | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | 22 | | 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | 23 | | 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, | 24 | | 356z.67, 356z.68, 356z.71, 364.01, 364.3, 367.2, 368a, 401, |
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| 1 | | 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) | 2 | | and (15) of Section 367 of the Illinois Insurance Code. | 3 | | Rulemaking authority to implement Public Act 95-1045, if | 4 | | any, is conditioned on the rules being adopted in accordance | 5 | | with all provisions of the Illinois Administrative Procedure | 6 | | Act and all rules and procedures of the Joint Committee on | 7 | | Administrative Rules; any purported rule not so adopted, for | 8 | | whatever reason, is unauthorized. | 9 | | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | 10 | | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. | 11 | | 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, | 12 | | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | 13 | | 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. | 14 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 15 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | 16 | | 103-551, eff. 8-11-23; revised 8-29-23.) | 17 | | Section 25. The Illinois Public Aid Code is amended by | 18 | | changing Section 5-16.8 as follows: | 19 | | (305 ILCS 5/5-16.8) | 20 | | Sec. 5-16.8. Required health benefits. The medical | 21 | | assistance program shall (i) provide the post-mastectomy care | 22 | | benefits required to be covered by a policy of accident and | 23 | | health insurance under Section 356t and the coverage required | 24 | | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, |
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| 1 | | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | 2 | | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and | 3 | | 356z.61 , 356z.64, 356z.67, and 356z.71 of the Illinois | 4 | | Insurance Code, (ii) be subject to the provisions of Sections | 5 | | 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the | 6 | | Illinois Insurance Code, and (iii) be subject to the | 7 | | provisions of subsection (d-5) of Section 10 of the Network | 8 | | Adequacy and Transparency Act. | 9 | | The Department, by rule, shall adopt a model similar to | 10 | | the requirements of Section 356z.39 of the Illinois Insurance | 11 | | Code. | 12 | | On and after July 1, 2012, the Department shall reduce any | 13 | | rate of reimbursement for services or other payments or alter | 14 | | any methodologies authorized by this Code to reduce any rate | 15 | | of reimbursement for services or other payments in accordance | 16 | | with Section 5-5e. | 17 | | To ensure full access to the benefits set forth in this | 18 | | Section, on and after January 1, 2016, the Department shall | 19 | | ensure that provider and hospital reimbursement for | 20 | | post-mastectomy care benefits required under this Section are | 21 | | no lower than the Medicare reimbursement rate. | 22 | | (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; | 23 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. | 24 | | 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, | 25 | | eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; | 26 | | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. |
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| 1 | | 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.) |
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