Full Text of HB4335 98th General Assembly
HB4335ham001 98TH GENERAL ASSEMBLY | Rep. Mary E. Flowers Filed: 3/19/2014
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| 1 | | AMENDMENT TO HOUSE BILL 4335
| 2 | | AMENDMENT NO. ______. Amend House Bill 4335 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Section 6.11 as follows:
| 6 | | (5 ILCS 375/6.11)
| 7 | | Sec. 6.11. Required health benefits; Illinois Insurance | 8 | | Code
requirements. The program of health
benefits shall provide | 9 | | the post-mastectomy care benefits required to be covered
by a | 10 | | policy of accident and health insurance under Section 356t of | 11 | | the Illinois
Insurance Code. The program of health benefits | 12 | | shall provide the coverage
required under Sections 356g, | 13 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 15 | | 356z.14, 356z.15, and 356z.17 , and 356z.22 of the
Illinois | 16 | | Insurance Code.
The program of health benefits must comply with |
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| 1 | | Sections 155.22a, 155.37, 355b, and 356z.19 of the
Illinois | 2 | | 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 10 | | eff. 7-13-12; 98-189, eff. 1-1-14.) | 11 | | Section 10. The Counties Code is amended by changing | 12 | | Section 5-1069.3 as follows: | 13 | | (55 ILCS 5/5-1069.3)
| 14 | | Sec. 5-1069.3. Required health benefits. If a county, | 15 | | including a home
rule
county, is a self-insurer for purposes of | 16 | | providing health insurance coverage
for its employees, the | 17 | | coverage shall include coverage for the post-mastectomy
care | 18 | | benefits required to be covered by a policy of accident and | 19 | | health
insurance under Section 356t and the coverage required | 20 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 21 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 22 | | 356z.14, and 356z.15 , and 356z.22 of
the Illinois Insurance | 23 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 24 | | and 356z.19 of
the Illinois Insurance Code. The requirement |
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| 1 | | that health benefits be covered
as provided in this Section is | 2 | | an
exclusive power and function of the State and is a denial | 3 | | and limitation under
Article VII, Section 6, subsection (h) of | 4 | | the Illinois Constitution. A home
rule county to which this | 5 | | Section applies must comply with every provision of
this | 6 | | Section.
| 7 | | Rulemaking authority to implement Public Act 95-1045, if | 8 | | any, is conditioned on the rules being adopted in accordance | 9 | | with all provisions of the Illinois Administrative Procedure | 10 | | Act and all rules and procedures of the Joint Committee on | 11 | | Administrative Rules; any purported rule not so adopted, for | 12 | | whatever reason, is unauthorized. | 13 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 14 | | eff. 7-13-12; 98-189, eff. 1-1-14.) | 15 | | Section 15. The Illinois Municipal Code is amended by | 16 | | changing Section 10-4-2.3 as follows: | 17 | | (65 ILCS 5/10-4-2.3)
| 18 | | Sec. 10-4-2.3. Required health benefits. If a | 19 | | municipality, including a
home rule municipality, is a | 20 | | self-insurer for purposes of providing health
insurance | 21 | | coverage for its employees, the coverage shall include coverage | 22 | | for
the post-mastectomy care benefits required to be covered by | 23 | | a policy of
accident and health insurance under Section 356t | 24 | | and the coverage required
under Sections 356g, 356g.5, |
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| 1 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 2 | | 356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 , and 356z.22 of | 3 | | the Illinois
Insurance
Code. The coverage shall comply with | 4 | | Sections 155.22a, 355b, and 356z.19 of
the Illinois Insurance | 5 | | Code. The requirement that health
benefits be covered as | 6 | | provided in this is an exclusive power and function of
the | 7 | | State and is a denial and limitation under Article VII, Section | 8 | | 6,
subsection (h) of the Illinois Constitution. A home rule | 9 | | municipality to which
this Section applies must comply with | 10 | | every provision of this Section.
| 11 | | Rulemaking authority to implement Public Act 95-1045, if | 12 | | any, is conditioned on the rules being adopted in accordance | 13 | | with all provisions of the Illinois Administrative Procedure | 14 | | Act and all rules and procedures of the Joint Committee on | 15 | | Administrative Rules; any purported rule not so adopted, for | 16 | | whatever reason, is unauthorized. | 17 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 18 | | eff. 7-13-12; 98-189, eff. 1-1-14.) | 19 | | Section 20. The Illinois Insurance Code is amended by | 20 | | adding Section 356z.22 as follows: | 21 | | (215 ILCS 5/356z.22 new) | 22 | | Sec. 356z.22. Hospital patient assessments. A group or | 23 | | individual policy of accident and health insurance or managed | 24 | | care plan amended, delivered, issued, or renewed after the |
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| 1 | | effective date of this amendatory Act of the 98th General | 2 | | Assembly that provides coverage for hospital care shall include | 3 | | in that coverage all services ordered by a physician and | 4 | | provided in the hospital that are considered medically | 5 | | necessary for the evaluation, assessment, and diagnosis of the | 6 | | illness or condition that resulted in the hospital stay of the | 7 | | enrollee or recipient. The services are subject to reasonable | 8 | | review and utilization standards required by the policy or plan | 9 | | for all hospital services, as defined by the Department or its | 10 | | successor agency. | 11 | | Section 25. The Illinois Public Aid Code is amended by | 12 | | changing Section 5-16.8 as follows:
| 13 | | (305 ILCS 5/5-16.8)
| 14 | | Sec. 5-16.8. Required health benefits. The medical | 15 | | assistance program
shall
(i) provide the post-mastectomy care | 16 | | benefits required to be covered by a policy of
accident and | 17 | | health insurance under Section 356t and the coverage required
| 18 | | under Sections 356g.5, 356u, 356w, 356x, and 356z.6 , and | 19 | | 356z.22 of the Illinois
Insurance Code and (ii) be subject to | 20 | | the provisions of Sections 356z.19 and 364.01 of the Illinois
| 21 | | Insurance Code.
| 22 | | On and after July 1, 2012, the Department shall reduce any | 23 | | rate of reimbursement for services or other payments or alter | 24 | | any methodologies authorized by this Code to reduce any rate of |
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| 1 | | reimbursement for services or other payments in accordance with | 2 | | Section 5-5e. | 3 | | (Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)
| 4 | | Section 30. The Medical Patient Rights Act is amended by | 5 | | changing Section 2.04 and adding Section 5.3 as follows:
| 6 | | (410 ILCS 50/2.04) (from Ch. 111 1/2, par. 5402.04)
| 7 | | Sec. 2.04.
"Insurance company" means (1) an insurance | 8 | | company, fraternal
benefit society, and any other insurer | 9 | | subject to regulation under the
Illinois Insurance Code; or (2) | 10 | | a health maintenance organization , a limited health service | 11 | | organization under the Limited Health Service Organization | 12 | | Act, or a voluntary health services plan under the Voluntary | 13 | | Health Services Plans Act .
| 14 | | (Source: P.A. 85-677; 85-679.)
| 15 | | (410 ILCS 50/5.3 new) | 16 | | Sec. 5.3. Patient notice of observation services. | 17 | | (a) Every general hospital shall provide patients who are | 18 | | placed into observation services by the general hospital with | 19 | | an oral and written notice within 24 hours after placement that | 20 | | the patient is not admitted to the hospital and is under | 21 | | observation status. The written notice shall be signed by the | 22 | | patient or the patient's legal representative to acknowledge | 23 | | receipt and shall include, but not be limited to, the following |
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| 1 | | information: | 2 | | (1) a statement that observation status may affect the | 3 | | patient's Medicare, Medicaid, and private insurance | 4 | | coverage for the current hospital services, including | 5 | | medications and other pharmaceutical supplies, as well as | 6 | | coverage for any subsequent discharge to a skilled nursing | 7 | | facility or home and community based care; and | 8 | | (2) that the patient should contact his or her | 9 | | insurance plan to better understand the implications of | 10 | | being placed in observation status. | 11 | | (b) The Director of Public Health shall develop and make | 12 | | available guidance on the notice as described in this Section. | 13 | | (c) The Director of Public Health shall direct the Long | 14 | | Term Care Advisory Committee and appropriate Department staff | 15 | | involved in regulating hospitals and nursing homes to | 16 | | investigate strategies for reducing the number of observation | 17 | | stays that extend past 48 hours, including exploring | 18 | | provisional and retroactive admissions. The Long Term Care | 19 | | Advisory Committee shall report to the Director, the Governor, | 20 | | the President of the Senate, and the Speaker of the House no | 21 | | later than 180 days after the effective date of this amendatory | 22 | | Act of the 98th General Assembly.
| 23 | | Section 99. Effective date. This Act takes effect upon | 24 | | becoming law.".
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