Full Text of HB1191 97th General Assembly
HB1191ham003 97TH GENERAL ASSEMBLY | Rep. Greg Harris Filed: 3/14/2011
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| 1 | | AMENDMENT TO HOUSE BILL 1191
| 2 | | AMENDMENT NO. ______. Amend House Bill 1191 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 364.01 as follows: | 6 | | (215 ILCS 5/364.01) | 7 | | Sec. 364.01. Qualified clinical cancer trials. | 8 | | (a) No individual or group policy of accident and health | 9 | | insurance issued or renewed in this State may be cancelled or | 10 | | non-renewed for any individual based on that individual's | 11 | | participation in a qualified clinical cancer trial. | 12 | | (b) Qualified clinical cancer trials must meet the | 13 | | following criteria: | 14 | | (1) the effectiveness of the treatment has not been | 15 | | determined relative to established therapies; | 16 | | (2) the trial is under clinical investigation as part |
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| 1 | | of an approved cancer research trial in Phase II, Phase | 2 | | III, or Phase IV of investigation; | 3 | | (3) the trial is: | 4 | | (A) approved by the Food and Drug Administration; | 5 | | or | 6 | | (B) approved and funded by the National Institutes | 7 | | of Health, the Centers for Disease Control and | 8 | | Prevention, the Agency for Healthcare Research and | 9 | | Quality, the United States Department of Defense, the | 10 | | United States Department of Veterans Affairs, or the | 11 | | United States Department of Energy in the form of an | 12 | | investigational new drug application, or a cooperative | 13 | | group or center of any entity described in this | 14 | | subdivision (B); and
| 15 | | (4) the patient's primary care physician, if any, is | 16 | | involved in the coordination of care.
| 17 | | (c) No group policy of accident and health insurance shall | 18 | | exclude coverage for any routine patient care administered to | 19 | | an insured who is a qualified individual participating in a | 20 | | qualified clinical cancer trial, if the policy covers that same | 21 | | routine patient care of insureds not enrolled in a qualified | 22 | | clinical cancer trial. | 23 | | (d) The coverage that may not be excluded under subsection | 24 | | (c) of this Section is subject to all terms, conditions, | 25 | | restrictions, exclusions, and limitations that apply to the | 26 | | same routine patient care received by an insured not enrolled |
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| 1 | | in a qualified clinical cancer trial, including the application | 2 | | of any authorization requirement, utilization review, or | 3 | | medical management practices. The insured or enrollee shall | 4 | | incur no greater out-of-pocket liability than had the insured | 5 | | or enrollee not enrolled in a qualified clinical cancer trial. | 6 | | (e) If the group policy of accident and health insurance | 7 | | uses a preferred provider program and a preferred provider | 8 | | provides routine patient care in connection with a qualified | 9 | | clinical cancer trial, then the insurer may require the insured | 10 | | to use the preferred provider if the preferred provider agrees | 11 | | to provide to the insured that routine patient care. | 12 | | (f) A qualified clinical cancer trial may not pay or refuse | 13 | | to pay for routine patient care of a individual participating | 14 | | in the trial, based in whole or in part on the person's having | 15 | | or not having coverage for routine patient care under a group | 16 | | policy of accident and health insurance. | 17 | | (g) Nothing in this Section shall be construed to limit an | 18 | | insurer's coverage with respect to clinical trials. | 19 | | (h) Nothing in this Section shall require coverage for | 20 | | out-of-network services where the underlying health benefit | 21 | | plan does not provide coverage for out-of-network services. | 22 | | (i) As used in this Section, "routine patient care" means | 23 | | all health care services provided in the qualified clinical | 24 | | cancer trial that are otherwise generally covered under the | 25 | | policy if those items or services were not provided in | 26 | | connection with a qualified clinical cancer trial consistent |
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| 1 | | with the standard of care for the treatment of cancer, | 2 | | including the type and frequency of any diagnostic modality, | 3 | | that a provider typically provides to a cancer patient who is | 4 | | not enrolled in a qualified clinical cancer trial. "Routine | 5 | | patient care" does not include, and a group policy of accident | 6 | | and health insurance may exclude, coverage for: | 7 | | (1) a health care service, item, or drug that is the | 8 | | subject of the cancer clinical trial; | 9 | | (2) a health care service, item, or drug provided | 10 | | solely to satisfy data collection and analysis needs for | 11 | | the qualified clinical cancer trial that is not used in the | 12 | | direct clinical management of the patient; | 13 | | (3) an investigational drug or device that has not been | 14 | | approved for market by the United States Food and Drug | 15 | | Administration; | 16 | | (4) transportation, lodging, food, or other expenses | 17 | | for the patient or a family member or companion of the | 18 | | patient that are associated with the travel to or from a | 19 | | facility providing the qualified clinical cancer trial, | 20 | | unless the policy covers these expenses for a cancer | 21 | | patient who is not enrolled in a qualified clinical cancer | 22 | | trial; | 23 | | (5) a health care service, item, or drug customarily | 24 | | provided by the qualified clinical cancer trial sponsors | 25 | | free of charge for any patient; | 26 | | (6) a health care service or item, which except for the |
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| 1 | | fact that it is being provided in a qualified clinical | 2 | | cancer trial, is otherwise specifically excluded from | 3 | | coverage under the insured's policy, including: | 4 | | (A) costs of extra treatments, services, | 5 | | procedures, tests, or drugs that would not be performed | 6 | | or administered except for the fact that the insured is | 7 | | participating in the cancer clinical trial; and | 8 | | (B) costs of nonhealth care services that the | 9 | | patient is required to receive as a result of | 10 | | participation in the approved cancer clinical trial; | 11 | | (7) costs for services, items, or drugs that are | 12 | | eligible for reimbursement from a source other than a | 13 | | patient's contract or policy providing for third-party | 14 | | payment or prepayment of health or medical expenses, | 15 | | including the sponsor of the approved cancer clinical | 16 | | trial; or | 17 | | (8) costs associated with approved cancer clinical | 18 | | trials designed exclusively to test toxicity or disease | 19 | | pathophysiology, unless the policy covers these expenses | 20 | | for a cancer patient who is not enrolled in a qualified | 21 | | clinical cancer trial; or | 22 | | (9) a health care service or item that is eligible for | 23 | | reimbursement by a source other than the insured's policy, | 24 | | including the sponsor of the qualified clinical cancer | 25 | | trial. | 26 | | The definitions of the terms "health care services", |
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| 1 | | "Non-Preferred Provider", "Preferred Provider", and "Preferred | 2 | | Provider Program", stated in 50 IL Adm. Code Part 2051 | 3 | | Preferred Provider Programs apply to these terms in this | 4 | | Section. | 5 | | (j) The external review procedures established under the | 6 | | Health Carrier External Review Act shall apply to the | 7 | | provisions under this Section. | 8 | | (Source: P.A. 93-1000, eff. 1-1-05.)
| 9 | | Section 99. Effective date. This Act takes effect January | 10 | | 1, 2012.".
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