Full Text of SB0661 99th General Assembly
SB0661sam001 99TH GENERAL ASSEMBLY | Sen. John G. Mulroe Filed: 3/20/2015
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| 1 | | AMENDMENT TO SENATE BILL 661
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 661 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | Hepatitis C Screening Act. | 6 | | Section 5. Definitions. For purposes of this Act: | 7 | | "Comprehensive physical examination" means a medical | 8 | | examination in which a health care practitioner takes a | 9 | | complete medical history to be used in the development of a | 10 | | comprehensive prevention and treatment plan, regardless of | 11 | | setting, including, but not limited to a physician's office, | 12 | | clinic, in-patient or out-patient facility. | 13 | | "Department" means the Department of Public Health. | 14 | | "Health care practitioner" means a physician licensed to | 15 | | practice medicine in all its branches, a physician assistant, | 16 | | or an advanced practice nurse. |
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| 1 | | "Primary care" means the medical fields of family medicine, | 2 | | general internal medicine, obstetrics, or gynecology. | 3 | | Section 10. Hepatitis C screening. | 4 | | (a) Health care practitioners offering primary care shall | 5 | | offer a one-time hepatitis C screening to persons born between | 6 | | the years of 1945 and 1965 during comprehensive physical | 7 | | examinations and for all new patients born between the years of | 8 | | 1945 and 1965. Nothing in this Act shall be construed to | 9 | | restrict a health care practitioner from recommending | 10 | | screening to any patient at any time. | 11 | | (b) Health care practitioners engaged in a comprehensive | 12 | | physical examination, regardless of setting, shall offer a | 13 | | one-time hepatitis C screening to persons born between the | 14 | | years of 1945 and 1965 any time blood is drawn for testing. | 15 | | (c) The requirements in subsections (a) and (b) do not | 16 | | apply when: | 17 | | (1) the health care practitioner reasonably believes | 18 | | that hepatitis C screening is contraindicated for the | 19 | | patient; | 20 | | (2) the health care practitioner believes an offer | 21 | | would interfere with the appropriate care and treatment of | 22 | | the patient under the circumstances; | 23 | | (3) the patient is being seen for an acute ailment, | 24 | | illness, or condition; | 25 | | (4) the patient is being evaluated or treated for an |
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| 1 | | emergency as defined by the federal Emergency Medical | 2 | | Treatment and Labor Act; or | 3 | | (5) the patient has been previously screened for | 4 | | hepatitis C. | 5 | | Section 15. Public health campaign. The Department shall | 6 | | conduct a public education campaign to describe the prevalence | 7 | | of hepatitis C, the risk factors for contracting hepatitis C, | 8 | | persons who should be screened, and complications and | 9 | | conditions resulting from hepatitis C. | 10 | | Section 90. Repealer. This Act is repealed on January 1, | 11 | | 2020. | 12 | | Section 900. The State Employees Group Insurance Act of | 13 | | 1971 is amended by changing Section 6.11 as follows:
| 14 | | (5 ILCS 375/6.11)
| 15 | | Sec. 6.11. Required health benefits; Illinois Insurance | 16 | | Code
requirements. The program of health
benefits shall provide | 17 | | the post-mastectomy care benefits required to be covered
by a | 18 | | policy of accident and health insurance under Section 356t of | 19 | | the Illinois
Insurance Code. The program of health benefits | 20 | | shall provide the coverage
required under Sections 356g, | 21 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 22 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
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| 1 | | 356z.14, 356z.15, 356z.17, and 356z.22 , and 356z.23 of the
| 2 | | Illinois Insurance Code.
The program of health benefits must | 3 | | comply with Sections 155.22a, 155.37, 355b, and 356z.19 of the
| 4 | | Illinois Insurance Code.
| 5 | | Rulemaking authority to implement Public Act 95-1045, if | 6 | | any, is conditioned on the rules being adopted in accordance | 7 | | with all provisions of the Illinois Administrative Procedure | 8 | | Act and all rules and procedures of the Joint Committee on | 9 | | Administrative Rules; any purported rule not so adopted, for | 10 | | whatever reason, is unauthorized. | 11 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 12 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .) | 13 | | Section 905. The Counties Code is amended by changing | 14 | | Section 5-1069.3 as follows: | 15 | | (55 ILCS 5/5-1069.3)
| 16 | | Sec. 5-1069.3. Required health benefits. If a county, | 17 | | including a home
rule
county, is a self-insurer for purposes of | 18 | | providing health insurance coverage
for its employees, the | 19 | | coverage shall include coverage for the post-mastectomy
care | 20 | | benefits required to be covered by a policy of accident and | 21 | | health
insurance under Section 356t and the coverage required | 22 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 23 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 24 | | 356z.14, 356z.15, and 356z.22 , and 356z.23 of
the Illinois |
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| 1 | | Insurance Code. The coverage shall comply with Sections | 2 | | 155.22a, 355b, and 356z.19 of
the Illinois Insurance Code. The | 3 | | requirement that health benefits be covered
as provided in this | 4 | | Section is an
exclusive power and function of the State and is | 5 | | a denial and limitation under
Article VII, Section 6, | 6 | | subsection (h) of the Illinois Constitution. A home
rule county | 7 | | to which this Section applies must comply with every provision | 8 | | of
this Section.
| 9 | | Rulemaking authority to implement Public Act 95-1045, if | 10 | | any, is conditioned on the rules being adopted in accordance | 11 | | with all provisions of the Illinois Administrative Procedure | 12 | | Act and all rules and procedures of the Joint Committee on | 13 | | Administrative Rules; any purported rule not so adopted, for | 14 | | whatever reason, is unauthorized. | 15 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 16 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .) | 17 | | Section 910. The Illinois Municipal Code is amended by | 18 | | changing Section 10-4-2.3 as follows: | 19 | | (65 ILCS 5/10-4-2.3)
| 20 | | Sec. 10-4-2.3. Required health benefits. If a | 21 | | municipality, including a
home rule municipality, is a | 22 | | self-insurer for purposes of providing health
insurance | 23 | | coverage for its employees, the coverage shall include coverage | 24 | | for
the post-mastectomy care benefits required to be covered by |
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| 1 | | a policy of
accident and health insurance under Section 356t | 2 | | and the coverage required
under Sections 356g, 356g.5, | 3 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 4 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22 , and | 5 | | 356z.23 of the Illinois
Insurance
Code. The coverage shall | 6 | | comply with Sections 155.22a, 355b, and 356z.19 of
the Illinois | 7 | | Insurance Code. The requirement that health
benefits be covered | 8 | | as provided in this is an exclusive power and function of
the | 9 | | State and is a denial and limitation under Article VII, Section | 10 | | 6,
subsection (h) of the Illinois Constitution. A home rule | 11 | | municipality to which
this Section applies must comply with | 12 | | every provision of this Section.
| 13 | | Rulemaking authority to implement Public Act 95-1045, if | 14 | | any, is conditioned on the rules being adopted in accordance | 15 | | with all provisions of the Illinois Administrative Procedure | 16 | | Act and all rules and procedures of the Joint Committee on | 17 | | Administrative Rules; any purported rule not so adopted, for | 18 | | whatever reason, is unauthorized. | 19 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 20 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .) | 21 | | Section 915. The School Code is amended by changing Section | 22 | | 10-22.3f as follows: | 23 | | (105 ILCS 5/10-22.3f)
| 24 | | Sec. 10-22.3f. Required health benefits. Insurance |
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| 1 | | protection and
benefits
for employees shall provide the | 2 | | post-mastectomy care benefits required to be
covered by a | 3 | | policy of accident and health insurance under Section 356t and | 4 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 5 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 6 | | 356z.13, 356z.14, 356z.15, and 356z.22 ,and 356z.23 of
the
| 7 | | Illinois Insurance Code.
Insurance policies shall comply with | 8 | | Section 356z.19 of the Illinois Insurance Code. The coverage | 9 | | shall comply with Sections 155.22a and 355b of
the Illinois | 10 | | Insurance Code.
| 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; 98-1091, eff. 1-1-15 .) | 19 | | Section 920. The Illinois Insurance Code is amended by | 20 | | adding Section 356z.23 as follows: | 21 | | (215 ILCS 5/356z.23 new) | 22 | | Sec. 356z.23. Hepatitis C testing. On and after the | 23 | | effective date of this amendatory Act of the 99th General | 24 | | Assembly, every insurer that amends, delivers, issues, or |
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| 1 | | renews a group or individual major medical policy of accident | 2 | | and health insurance in this State providing coverage for | 3 | | hospital or medical treatment shall provide coverage for | 4 | | hepatitis C screening and confirmatory testing consistent with | 5 | | reasonable medical standards. | 6 | | Section 925. The Health Maintenance Organization Act is | 7 | | amended by changing Section 5-3 as follows:
| 8 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 9 | | Sec. 5-3. Insurance Code provisions.
| 10 | | (a) Health Maintenance Organizations
shall be subject to | 11 | | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| 12 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | 13 | | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | 14 | | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | 15 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 16 | | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | 17 | | 356z.22, 356z.23, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, | 18 | | 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
| 19 | | 408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | 20 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
| 21 | | XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois | 22 | | Insurance Code.
| 23 | | (b) For purposes of the Illinois Insurance Code, except for | 24 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health |
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| 1 | | Maintenance Organizations in
the following categories are | 2 | | deemed to be "domestic companies":
| 3 | | (1) a corporation authorized under the
Dental Service | 4 | | Plan Act or the Voluntary Health Services Plans Act;
| 5 | | (2) a corporation organized under the laws of this | 6 | | State; or
| 7 | | (3) a corporation organized under the laws of another | 8 | | state, 30% or more
of the enrollees of which are residents | 9 | | of this State, except a
corporation subject to | 10 | | substantially the same requirements in its state of
| 11 | | organization as is a "domestic company" under Article VIII | 12 | | 1/2 of the
Illinois Insurance Code.
| 13 | | (c) In considering the merger, consolidation, or other | 14 | | acquisition of
control of a Health Maintenance Organization | 15 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 16 | | (1) the Director shall give primary consideration to | 17 | | the continuation of
benefits to enrollees and the financial | 18 | | conditions of the acquired Health
Maintenance Organization | 19 | | after the merger, consolidation, or other
acquisition of | 20 | | control takes effect;
| 21 | | (2)(i) the criteria specified in subsection (1)(b) of | 22 | | Section 131.8 of
the Illinois Insurance Code shall not | 23 | | apply and (ii) the Director, in making
his determination | 24 | | with respect to the merger, consolidation, or other
| 25 | | acquisition of control, need not take into account the | 26 | | effect on
competition of the merger, consolidation, or |
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| 1 | | other acquisition of control;
| 2 | | (3) the Director shall have the power to require the | 3 | | following
information:
| 4 | | (A) certification by an independent actuary of the | 5 | | adequacy
of the reserves of the Health Maintenance | 6 | | Organization sought to be acquired;
| 7 | | (B) pro forma financial statements reflecting the | 8 | | combined balance
sheets of the acquiring company and | 9 | | the Health Maintenance Organization sought
to be | 10 | | acquired as of the end of the preceding year and as of | 11 | | a date 90 days
prior to the acquisition, as well as pro | 12 | | forma financial statements
reflecting projected | 13 | | combined operation for a period of 2 years;
| 14 | | (C) a pro forma business plan detailing an | 15 | | acquiring party's plans with
respect to the operation | 16 | | of the Health Maintenance Organization sought to
be | 17 | | acquired for a period of not less than 3 years; and
| 18 | | (D) such other information as the Director shall | 19 | | require.
| 20 | | (d) The provisions of Article VIII 1/2 of the Illinois | 21 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 22 | | any health maintenance
organization of greater than 10% of its
| 23 | | enrollee population (including without limitation the health | 24 | | maintenance
organization's right, title, and interest in and to | 25 | | its health care
certificates).
| 26 | | (e) In considering any management contract or service |
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| 1 | | agreement subject
to Section 141.1 of the Illinois Insurance | 2 | | Code, the Director (i) shall, in
addition to the criteria | 3 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 4 | | into account the effect of the management contract or
service | 5 | | agreement on the continuation of benefits to enrollees and the
| 6 | | financial condition of the health maintenance organization to | 7 | | be managed or
serviced, and (ii) need not take into account the | 8 | | effect of the management
contract or service agreement on | 9 | | competition.
| 10 | | (f) Except for small employer groups as defined in the | 11 | | Small Employer
Rating, Renewability and Portability Health | 12 | | Insurance Act and except for
medicare supplement policies as | 13 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 14 | | Maintenance Organization may by contract agree with a
group or | 15 | | other enrollment unit to effect refunds or charge additional | 16 | | premiums
under the following terms and conditions:
| 17 | | (i) the amount of, and other terms and conditions with | 18 | | respect to, the
refund or additional premium are set forth | 19 | | in the group or enrollment unit
contract agreed in advance | 20 | | of the period for which a refund is to be paid or
| 21 | | additional premium is to be charged (which period shall not | 22 | | be less than one
year); and
| 23 | | (ii) the amount of the refund or additional premium | 24 | | shall not exceed 20%
of the Health Maintenance | 25 | | Organization's profitable or unprofitable experience
with | 26 | | respect to the group or other enrollment unit for the |
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| 1 | | period (and, for
purposes of a refund or additional | 2 | | premium, the profitable or unprofitable
experience shall | 3 | | be calculated taking into account a pro rata share of the
| 4 | | Health Maintenance Organization's administrative and | 5 | | marketing expenses, but
shall not include any refund to be | 6 | | made or additional premium to be paid
pursuant to this | 7 | | subsection (f)). The Health Maintenance Organization and | 8 | | the
group or enrollment unit may agree that the profitable | 9 | | or unprofitable
experience may be calculated taking into | 10 | | account the refund period and the
immediately preceding 2 | 11 | | plan years.
| 12 | | The Health Maintenance Organization shall include a | 13 | | statement in the
evidence of coverage issued to each enrollee | 14 | | describing the possibility of a
refund or additional premium, | 15 | | and upon request of any group or enrollment unit,
provide to | 16 | | the group or enrollment unit a description of the method used | 17 | | to
calculate (1) the Health Maintenance Organization's | 18 | | profitable experience with
respect to the group or enrollment | 19 | | unit and the resulting refund to the group
or enrollment unit | 20 | | or (2) the Health Maintenance Organization's unprofitable
| 21 | | experience with respect to the group or enrollment unit and the | 22 | | resulting
additional premium to be paid by the group or | 23 | | enrollment unit.
| 24 | | In no event shall the Illinois Health Maintenance | 25 | | Organization
Guaranty Association be liable to pay any | 26 | | contractual obligation of an
insolvent organization to pay any |
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| 1 | | refund authorized under this Section.
| 2 | | (g) Rulemaking authority to implement Public Act 95-1045, | 3 | | if any, is conditioned on the rules being adopted in accordance | 4 | | with all provisions of the Illinois Administrative Procedure | 5 | | Act and all rules and procedures of the Joint Committee on | 6 | | Administrative Rules; any purported rule not so adopted, for | 7 | | whatever reason, is unauthorized. | 8 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437, | 9 | | eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, | 10 | | eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; | 11 | | 98-1091, eff. 1-1-15 .) | 12 | | Section 930. The Voluntary Health Services Plans Act is | 13 | | amended by changing Section 10 as follows:
| 14 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 15 | | Sec. 10. Application of Insurance Code provisions. Health | 16 | | services
plan corporations and all persons interested therein | 17 | | or dealing therewith
shall be subject to the provisions of | 18 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 19 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g, | 20 | | 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, | 21 | | 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
| 22 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | 23 | | 356z.19, 356z.21, 356z.22, 356z.23, 364.01, 367.2, 368a, 401, | 24 | | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) |
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| 1 | | and (15) of Section 367 of the Illinois
Insurance Code.
| 2 | | Rulemaking authority to implement Public Act 95-1045, if | 3 | | any, is conditioned on the rules being adopted in accordance | 4 | | with all provisions of the Illinois Administrative Procedure | 5 | | Act and all rules and procedures of the Joint Committee on | 6 | | Administrative Rules; any purported rule not so adopted, for | 7 | | whatever reason, is unauthorized. | 8 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486, | 9 | | eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, | 10 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .) | 11 | | Section 935. 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.23 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.)".
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