Full Text of HB2347 101st General Assembly
HB2347 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 HB2347 Introduced 2/13/2019, by Rep. Gregory Harris SYNOPSIS AS INTRODUCED: |
| 5 ILCS 375/6.11 | | 55 ILCS 5/5-1069.3 | | 65 ILCS 5/10-4-2.3 | | 105 ILCS 5/10-22.3f | | 215 ILCS 134/10 | | 305 ILCS 5/5-16.8 | |
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Amends the Managed Care Reform and Patient Rights Act. Provides that specified medical conditions are included in the definition of "emergency medical condition" regardless of the final diagnosis that is given. Provides that provisions concerning emergency services prior to stabilization also apply to the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, and the Illinois Public Aid Code.
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| | FISCAL NOTE ACT MAY APPLY | | STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT |
| | A BILL FOR |
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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 State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Section 6.11 as follows:
| 6 | | (5 ILCS 375/6.11)
| 7 | | (Text of Section before amendment by P.A. 100-1170 ) | 8 | | Sec. 6.11. Required health benefits; Illinois Insurance | 9 | | Code
requirements. The program of health
benefits shall provide | 10 | | the post-mastectomy care benefits required to be covered
by a | 11 | | policy of accident and health insurance under Section 356t of | 12 | | the Illinois
Insurance Code. The program of health benefits | 13 | | shall provide the coverage
required under Sections 356g, | 14 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 15 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 16 | | 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and | 17 | | 356z.29 , and 356z.32 of the
Illinois Insurance Code.
The | 18 | | program of health benefits must comply with Sections 155.22a, | 19 | | 155.37, 355b, 356z.19, 370c, and 370c.1 of the
Illinois | 20 | | Insurance Code and Section 65 of the Managed Care Reform and | 21 | | Patient Rights Act . The Department of Insurance shall enforce | 22 | | the requirements of this Section.
| 23 | | Rulemaking authority to implement Public Act 95-1045, if |
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| 1 | | any, is conditioned on the rules being adopted in accordance | 2 | | with all provisions of the Illinois Administrative Procedure | 3 | | Act and all rules and procedures of the Joint Committee on | 4 | | Administrative Rules; any purported rule not so adopted, for | 5 | | whatever reason, is unauthorized. | 6 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 7 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 8 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 9 | | 1-8-19.) | 10 | | (Text of Section after amendment by P.A. 100-1170 ) | 11 | | Sec. 6.11. Required health benefits; Illinois Insurance | 12 | | Code
requirements. The program of health
benefits shall provide | 13 | | the post-mastectomy care benefits required to be covered
by a | 14 | | policy of accident and health insurance under Section 356t of | 15 | | the Illinois
Insurance Code. The program of health benefits | 16 | | shall provide the coverage
required under Sections 356g, | 17 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 18 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 19 | | 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, | 20 | | and 356z.32 of the
Illinois Insurance Code.
The program of | 21 | | health benefits must comply with Sections 155.22a, 155.37, | 22 | | 355b, 356z.19, 370c, and 370c.1 of the
Illinois Insurance Code | 23 | | and Section 65 of the Managed Care Reform and Patient Rights | 24 | | Act . The Department of Insurance shall enforce the requirements | 25 | | of this Section with respect to Sections 370c and 370c.1 of the |
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| 1 | | Illinois Insurance Code; all other requirements of this Section | 2 | | shall be enforced by the Department of Central Management | 3 | | Services.
| 4 | | Rulemaking authority to implement Public Act 95-1045, if | 5 | | any, is conditioned on the rules being adopted in accordance | 6 | | with all provisions of the Illinois Administrative Procedure | 7 | | Act and all rules and procedures of the Joint Committee on | 8 | | Administrative Rules; any purported rule not so adopted, for | 9 | | whatever reason, is unauthorized. | 10 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 11 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 12 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; | 13 | | 100-1170, eff. 6-1-19.) | 14 | | Section 10. The Counties Code is amended by changing | 15 | | Section 5-1069.3 as follows: | 16 | | (55 ILCS 5/5-1069.3)
| 17 | | Sec. 5-1069.3. Required health benefits. If a county, | 18 | | including a home
rule
county, is a self-insurer for purposes of | 19 | | providing health insurance coverage
for its employees, the | 20 | | coverage shall include coverage for the post-mastectomy
care | 21 | | benefits required to be covered by a policy of accident and | 22 | | health
insurance under Section 356t and the coverage required | 23 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 24 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
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| 1 | | 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29 , | 2 | | and 356z.32 of
the Illinois Insurance Code. The coverage shall | 3 | | comply with Sections 155.22a, 355b, 356z.19, and 370c of
the | 4 | | Illinois Insurance Code and Section 65 of the Managed Care | 5 | | Reform and Patient Rights Act . The Department of Insurance | 6 | | shall enforce the requirements of this Section. The requirement | 7 | | that health benefits be covered
as provided in this Section is | 8 | | an
exclusive power and function of the State and is a denial | 9 | | and limitation under
Article VII, Section 6, subsection (h) of | 10 | | the Illinois Constitution. A home
rule county to which this | 11 | | Section applies must comply with every provision of
this | 12 | | 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. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 20 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 21 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 22 | | 10-3-18.) | 23 | | Section 15. The Illinois Municipal Code is amended by | 24 | | changing Section 10-4-2.3 as follows: |
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| 1 | | (65 ILCS 5/10-4-2.3)
| 2 | | Sec. 10-4-2.3. Required health benefits. If a | 3 | | municipality, including a
home rule municipality, is a | 4 | | self-insurer for purposes of providing health
insurance | 5 | | coverage for its employees, the coverage shall include coverage | 6 | | for
the post-mastectomy care benefits required to be covered by | 7 | | a policy of
accident and health insurance under Section 356t | 8 | | and the coverage required
under Sections 356g, 356g.5, | 9 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 10 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, | 11 | | and 356z.26, and 356z.29 , and 356z.32 of the Illinois
Insurance
| 12 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 13 | | 356z.19, and 370c of
the Illinois Insurance Code and Section 65 | 14 | | of the Managed Care Reform and Patient Rights Act . The | 15 | | Department of Insurance shall enforce the requirements of this | 16 | | Section. The requirement that health
benefits be covered as | 17 | | provided in this is an exclusive power and function of
the | 18 | | State and is a denial and limitation under Article VII, Section | 19 | | 6,
subsection (h) of the Illinois Constitution. A home rule | 20 | | municipality to which
this Section applies must comply with | 21 | | every provision of this Section.
| 22 | | Rulemaking authority to implement Public Act 95-1045, if | 23 | | any, is conditioned on the rules being adopted in accordance | 24 | | with all provisions of the Illinois Administrative Procedure | 25 | | Act and all rules and procedures of the Joint Committee on | 26 | | Administrative Rules; any purported rule not so adopted, for |
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| 1 | | whatever reason, is unauthorized. | 2 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 3 | | 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff. | 4 | | 1-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 5 | | 10-4-18.) | 6 | | Section 20. The School Code is amended by changing Section | 7 | | 10-22.3f as follows: | 8 | | (105 ILCS 5/10-22.3f)
| 9 | | Sec. 10-22.3f. Required health benefits. Insurance | 10 | | protection and
benefits
for employees shall provide the | 11 | | post-mastectomy care benefits required to be
covered by a | 12 | | policy of accident and health insurance under Section 356t and | 13 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 14 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 15 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and | 16 | | 356z.29 , and 356z.32 of
the
Illinois Insurance Code.
Insurance | 17 | | policies shall comply with Section 356z.19 of the Illinois | 18 | | Insurance Code. The coverage shall comply with Sections | 19 | | 155.22a, 355b, and 370c of
the Illinois Insurance Code and | 20 | | Section 65 of the Managed Care Reform and Patient Rights Act . | 21 | | The Department of Insurance shall enforce the requirements of | 22 | | this Section.
| 23 | | Rulemaking authority to implement Public Act 95-1045, if | 24 | | any, is conditioned on the rules being adopted in accordance |
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| 1 | | with all provisions of the Illinois Administrative Procedure | 2 | | Act and all rules and procedures of the Joint Committee on | 3 | | Administrative Rules; any purported rule not so adopted, for | 4 | | whatever reason, is unauthorized. | 5 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 6 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 7 | | 1-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.) | 8 | | Section 25. The Managed Care Reform and Patient Rights Act | 9 | | is amended by changing Section 10 as follows:
| 10 | | (215 ILCS 134/10)
| 11 | | Sec. 10. Definitions.
| 12 | | "Adverse determination" means a determination by a health | 13 | | care plan under
Section 45 or by a utilization review program | 14 | | under Section
85 that
a health care service is not medically | 15 | | necessary.
| 16 | | "Clinical peer" means a health care professional who is in | 17 | | the same
profession and the same or similar specialty as the | 18 | | health care provider who
typically manages the medical | 19 | | condition, procedures, or treatment under
review.
| 20 | | "Department" means the Department of Insurance.
| 21 | | "Emergency medical condition" means a medical condition | 22 | | manifesting itself by
acute symptoms of sufficient severity | 23 | | (including, but not limited to, severe
pain) , regardless of the | 24 | | final diagnosis that is given, such that a prudent
layperson, |
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| 1 | | who possesses an average knowledge of health and medicine, | 2 | | could
reasonably expect the absence of immediate medical | 3 | | attention to result in:
| 4 | | (1) placing the health of the individual (or, with | 5 | | respect to a pregnant
woman, the
health of the woman or her | 6 | | unborn child) in serious jeopardy;
| 7 | | (2) serious
impairment to bodily functions; or
| 8 | | (3) serious dysfunction of any bodily organ
or part.
| 9 | | "Emergency medical screening examination" means a medical | 10 | | screening
examination and
evaluation by a physician licensed to | 11 | | practice medicine in all its branches, or
to the extent | 12 | | permitted
by applicable laws, by other appropriately licensed | 13 | | personnel under the
supervision of or in
collaboration with a | 14 | | physician licensed to practice medicine in all its
branches to | 15 | | determine whether
the need for emergency services exists.
| 16 | | "Emergency services" means, with respect to an enrollee of | 17 | | a health care
plan,
transportation services, including but not | 18 | | limited to ambulance services, and
covered inpatient and | 19 | | outpatient hospital services
furnished by a provider
qualified | 20 | | to furnish those services that are needed to evaluate or | 21 | | stabilize an
emergency medical condition. "Emergency services" | 22 | | does not
refer to post-stabilization medical services.
| 23 | | "Enrollee" means any person and his or her dependents | 24 | | enrolled in or covered
by a health care plan.
| 25 | | "Health care plan" means a plan, including, but not limited | 26 | | to, a health maintenance organization, a managed care community |
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| 1 | | network as defined in the Illinois Public Aid Code, or an | 2 | | accountable care entity as defined in the Illinois Public Aid | 3 | | Code that receives capitated payments to cover medical services | 4 | | from the Department of Healthcare and Family Services, that | 5 | | establishes, operates, or maintains a
network of health care | 6 | | providers that has entered into an agreement with the
plan to | 7 | | provide health care services to enrollees to whom the plan has | 8 | | the
ultimate obligation to arrange for the provision of or | 9 | | payment for services
through organizational arrangements for | 10 | | ongoing quality assurance,
utilization review programs, or | 11 | | dispute resolution.
Nothing in this definition shall be | 12 | | construed to mean that an independent
practice association or a | 13 | | physician hospital organization that subcontracts
with
a | 14 | | health care plan is, for purposes of that subcontract, a health | 15 | | care plan.
| 16 | | For purposes of this definition, "health care plan" shall | 17 | | not include the
following:
| 18 | | (1) indemnity health insurance policies including | 19 | | those using a contracted
provider network;
| 20 | | (2) health care plans that offer only dental or only | 21 | | vision coverage;
| 22 | | (3) preferred provider administrators, as defined in | 23 | | Section 370g(g) of
the
Illinois Insurance Code;
| 24 | | (4) employee or employer self-insured health benefit | 25 | | plans under the
federal Employee Retirement Income | 26 | | Security Act of 1974;
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| 1 | | (5) health care provided pursuant to the Workers' | 2 | | Compensation Act or the
Workers' Occupational Diseases | 3 | | Act; and
| 4 | | (6) not-for-profit voluntary health services plans | 5 | | with health maintenance
organization
authority in | 6 | | existence as of January 1, 1999 that are affiliated with a | 7 | | union
and that
only extend coverage to union members and | 8 | | their dependents.
| 9 | | "Health care professional" means a physician, a registered | 10 | | professional
nurse,
or other individual appropriately licensed | 11 | | or registered
to provide health care services.
| 12 | | "Health care provider" means any physician, hospital | 13 | | facility, facility licensed under the Nursing Home Care Act, | 14 | | long-term care facility as defined in Section 1-113 of the | 15 | | Nursing Home Care Act, or other
person that is licensed or | 16 | | otherwise authorized to deliver health care
services. Nothing | 17 | | in this
Act shall be construed to define Independent Practice | 18 | | Associations or
Physician-Hospital Organizations as health | 19 | | care providers.
| 20 | | "Health care services" means any services included in the | 21 | | furnishing to any
individual of medical care, or the
| 22 | | hospitalization incident to the furnishing of such care, as | 23 | | well as the
furnishing to any person of
any and all other | 24 | | services for the purpose of preventing,
alleviating, curing, or | 25 | | healing human illness or injury including home health
and | 26 | | pharmaceutical services and products.
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| 1 | | "Medical director" means a physician licensed in any state | 2 | | to practice
medicine in all its
branches appointed by a health | 3 | | care plan.
| 4 | | "Person" means a corporation, association, partnership,
| 5 | | limited liability company, sole proprietorship, or any other | 6 | | legal entity.
| 7 | | "Physician" means a person licensed under the Medical
| 8 | | Practice Act of 1987.
| 9 | | "Post-stabilization medical services" means health care | 10 | | services
provided to an enrollee that are furnished in a | 11 | | licensed hospital by a provider
that is qualified to furnish | 12 | | such services, and determined to be medically
necessary and | 13 | | directly related to the emergency medical condition following
| 14 | | stabilization.
| 15 | | "Stabilization" means, with respect to an emergency | 16 | | medical condition, to
provide such medical treatment of the | 17 | | condition as may be necessary to assure,
within reasonable | 18 | | medical probability, that no material deterioration
of the | 19 | | condition is likely to result.
| 20 | | "Utilization review" means the evaluation of the medical | 21 | | necessity,
appropriateness, and efficiency of the use of health | 22 | | care services, procedures,
and facilities.
| 23 | | "Utilization review program" means a program established | 24 | | by a person to
perform utilization review.
| 25 | | (Source: P.A. 98-651, eff. 6-16-14; 98-841, eff. 8-1-14; 99-78, | 26 | | eff. 7-20-15.)
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| 1 | | Section 30. The Illinois Public Aid Code is amended by | 2 | | changing Section 5-16.8 as follows:
| 3 | | (305 ILCS 5/5-16.8)
| 4 | | Sec. 5-16.8. Required health benefits. The medical | 5 | | assistance program
shall
(i) provide the post-mastectomy care | 6 | | benefits required to be covered by a policy of
accident and | 7 | | health insurance under Section 356t and the coverage required
| 8 | | under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and | 9 | | 356z.29 , and 356z.32 of the Illinois
Insurance Code and (ii) be | 10 | | subject to the provisions of Sections 356z.19, 364.01, 370c, | 11 | | and 370c.1 of the Illinois
Insurance Code and Section 65 of the | 12 | | Managed Care Reform and Patient Rights Act .
| 13 | | On and after July 1, 2012, the Department shall reduce any | 14 | | rate of reimbursement for services or other payments or alter | 15 | | any methodologies authorized by this Code to reduce any rate of | 16 | | reimbursement for services or other payments in accordance with | 17 | | Section 5-5e. | 18 | | To ensure full access to the benefits set forth in this | 19 | | Section, on and after January 1, 2016, the Department shall | 20 | | ensure that provider and hospital reimbursement for | 21 | | post-mastectomy care benefits required under this Section are | 22 | | no lower than the Medicare reimbursement rate. | 23 | | (Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15; | 24 | | 99-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff. |
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| 1 | | 8-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | 2 | | 10-4-18.)
| 3 | | Section 95. No acceleration or delay. Where this Act makes | 4 | | changes in a statute that is represented in this Act by text | 5 | | that is not yet or no longer in effect (for example, a Section | 6 | | represented by multiple versions), the use of that text does | 7 | | not accelerate or delay the taking effect of (i) the changes | 8 | | made by this Act or (ii) provisions derived from any other | 9 | | Public Act.
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