Illinois General Assembly - Full Text of HB0579
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Full Text of HB0579  103rd General Assembly


Rep. Robyn Gabel

Filed: 3/23/2023





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2    AMENDMENT NO. ______. Amend House Bill 579 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Administrative Procedure Act is
5amended by adding Section 5-45.35 as follows:
6    (5 ILCS 100/5-45.35 new)
7    Sec. 5-45.35. Emergency rulemaking; Illinois Health
8Benefits Exchange Law. To provide for the expeditious and
9timely implementation of Section 5-23 of the Illinois Health
10Benefits Exchange Law, emergency rules implementing Section
115-23 of the Illinois Health Benefits Exchange Law may be
12adopted in accordance with Section 5-45 of this Act by the
13Department of Insurance and the Department of Healthcare and
14Family Services. The adoption of emergency rules authorized by
15Section 5-45 and this Section is deemed to be necessary for the
16public interest, safety, and welfare.



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1    This Section is repealed January 1, 2025.
2    Section 10. The Illinois Health Benefits Exchange Law is
3amended by changing Section 5-5 and by adding Sections 5-21,
45-22, 5-23, and 5-24 as follows:
5    (215 ILCS 122/5-5)
6    Sec. 5-5. State health benefits exchange. It is declared
7that this State, beginning October 1, 2013, in accordance with
8Section 1311 of the federal Patient Protection and Affordable
9Care Act, shall establish a State health benefits exchange to
10be known as the Illinois Health Benefits Exchange in order to
11help individuals and small employers with no more than 50
12employees shop for, select, and enroll in qualified,
13affordable private health plans that fit their needs at
14competitive prices. The Exchange shall separate coverage pools
15for individuals and small employers and shall supplement and
16not supplant any existing private health insurance market for
17individuals and small employers. The Department of Insurance
18shall operate the Illinois Health Benefits Exchange as a
19State-based exchange using the federal platform by plan year
202025 and as a State-based exchange by plan year 2026. The
21Director of Insurance may require that all plans in the
22individual and small group markets, other than grandfathered
23health plans, be made available for comparison on the Illinois
24Health Benefits Exchange, but may not require that all plans



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1in the individual and small group markets be purchased
2exclusively on the Illinois Health Benefits Exchange. The
3Director of Insurance may require that plans offered on the
4exchange conform with standardized plan designs that provide
5for standardized cost sharing for covered health services.
6Except when it is inconsistent with State law, the Department
7of Insurance shall enforce the coverage requirements under the
8federal Patient Protection and Affordable Care Act, including
9the coverage of all United States Preventive Services Task
10Force Grade A & B preventive services without cost sharing
11notwithstanding any federal overturning or repeal of 42 U.S.C.
12300gg-13(a)(1), that apply to the individual and small group
13markets. The Director of Insurance may elect to add a small
14business health options program to the Illinois Health
15Benefits Exchange to help small employers enroll their
16employees in qualified health plans in the small group market.
17The General Assembly shall appropriate funds to establish the
18Illinois Health Benefits Exchange.
19(Source: P.A. 97-142, eff. 7-14-11.)
20    (215 ILCS 122/5-21 new)
21    Sec. 5-21. Monthly assessments.
22    (a) The Director of Insurance may apply a monthly
23assessment to each health benefits plan sold on the Illinois
24Health Benefits Exchange. The assessment shall be paid by the
25issuer and to the Department of Insurance and shall be used



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1only for the purpose of supporting the exchange through
2exchange operations, outreach, enrollment, and other means of
3supporting the exchange, including any efforts that may
4increase market stabilization and that may result in a net
5benefit to policyholders. The assessment may be applied at a
6rate of:
7        (1) 0.5% of the total monthly premium charged by an
8    issuer for each health benefits plan during any period
9    that the State is on a State-based exchange using the
10    federal platform; or
11        (2) 2.75% of the total monthly premium charged by an
12    issuer for each health benefits plan during any period
13    that the State is on the State-based exchange. The
14    Director of Insurance shall adjust this rate to ensure
15    that the Illinois Health Benefits Exchange is fully
16    funded, but in no case shall the assessment be applied at a
17    rate that exceeds 4% of the total monthly premium charged
18    by a carrier. If the Director determines it is necessary
19    to adjust the rate pursuant to this paragraph, the
20    Director shall, in advance of the adjustment, post on the
21    Department's website a report describing the reasons and
22    justifications for the adjustment, which shall be
23    consistent with the purposes of supporting the Illinois
24    Health Benefits Exchange as provided in this Section.
25    (b) The Director of Insurance shall notify an issuer of
26its assessment rate for the subsequent year. Issuers must



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1remit the assessment due in monthly installments to the
2Department of Insurance.
3    (c) The assessment described in this Section shall be
4considered a special purpose obligation and may not be applied
5by issuers to vary premium rates at the plan level.
6    (d) There is created a revolving fund to be known as the
7Illinois Health Benefits Exchange Fund, to be held by the
8Department of Insurance. The Illinois Health Benefits Exchange
9Fund shall be the repository for moneys collected pursuant to
10fees or assessments on exchange issuers, federal financial
11participation as appropriate, and other moneys received as
12grants or otherwise appropriated for the purposes of
13supporting health insurance outreach, enrollment efforts, and
14plan management operations through an exchange. All moneys in
15the Fund shall be used only for the purpose of supporting the
16exchange through exchange operations, outreach, enrollment,
17and other means of supporting the exchange, including any
18efforts that may increase market stabilization and that may
19result in a net benefit to policyholders.
20    (215 ILCS 122/5-22 new)
21    Sec. 5-22. State medical assistance program coordination.
22    (a) The Department of Insurance and the Department of
23Healthcare and Family Services shall coordinate the operations
24of the exchange with the operations of State medical
25assistance programs. The Department of Healthcare and Family



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1Services shall oversee and operate the exchange eligibility
2rules engine to ensure accurate assessments and determinations
3of exchange and State medical assistance program eligibility.
4    (b) The exchange may determine eligibility for State
5medical assistance programs that use the modified adjusted
6gross income methodology.
7    (c) The exchange may be used for enrollment into State
8medical assistance program health plans.
9    (d) The Department of Healthcare and Family Services shall
10request federal financial participation funds from the Centers
11for Medicare and Medicaid Services for any integrated
12eligibility and enrollment functions of the exchange.
13    (215 ILCS 122/5-23 new)
14    Sec. 5-23. Department of Insurance and Department of
15Healthcare and Family Services authority.
16    (a) The Department of Insurance and the Department of
17Healthcare and Family Services, in addition to the powers
18granted under the Illinois Insurance Code and the Illinois
19Public Aid Code, have the power necessary to establish and
20operate the Illinois Health Benefits Exchange, including, but
21not limited to, the authority to:
22        (1) adopt rules deemed necessary by the departments to
23    implement this Law;
24        (2) employ or retain sufficient personnel to provide
25    administration, staffing, and necessary related support



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1    required to adequately discharge the duties described in
2    this Law from funds held in the Illinois Health Benefits
3    Exchange Fund;
4        (3) procure services, including a call center, and
5    goods for the purpose of establishing the Illinois Health
6    Benefits Exchange as emergency purchases as set forth in
7    Section 20-30 of the Illinois Procurement Code;
8        (4) require any exchange vendor to have experience
9    operating a State-based exchange in another state; and
10        (5) implement programs that increase the affordability
11    of or access to health insurance coverage, including for
12    populations currently not eligible to enroll in the
13    Illinois Health Benefits Exchange, through Section 1332
14    waivers under the federal Patient Protection and
15    Affordable Care Act or other available federal waivers and
16    authorities.
17    (b) The Department of Insurance has the authority to
18employ a Chief Operating Officer of the Illinois Health
19Benefits Exchange. The Chief Operating Officer shall be
20subject to confirmation by the Senate.
21    (215 ILCS 122/5-24 new)
22    Sec. 5-24. Illinois Health Benefits Exchange Advisory
24    (a) The Director of Insurance shall establish the Illinois
25Health Benefits Exchange Advisory Committee no later than



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1December 31, 2023. The Illinois Health Benefits Exchange
2Advisory Committee shall be tasked with making recommendations
3to the Chief Operating Officer of the Illinois Health Benefits
4Exchange concerning the operation of the exchange, and the
5Committee shall hold its first meeting no later than 90 days
6following the establishment of the Committee and shall meet
7quarterly thereafter. The Chief Operating Officer shall make a
8quarterly report to the Committee.
9    (b) The Department of Insurance shall present regular and
10timely reports to the Illinois Health Benefits Exchange
11Advisory Committee regarding the progress in the development
12of the Illinois Health Benefits Exchange before its
13establishment by plan year 2026. The reports shall be posted
14to the Department of Insurance's website and include
15information on the Department of Insurance's progress toward
16establishing and maintaining the Illinois Health Benefits
17Exchange with the goal of ensuring an effective and efficient
18transition from the federal platform to the State-based
19exchange for individuals, employers, and health insurance
20issuers while mitigating loss of health insurance coverage for
21any potential consumer. The Department of Insurance's progress
22reports shall include information regarding transparency, user
23understandability, plan compliance, outreach and education,
24and systems operations. The Department of Insurance shall
25gather stakeholder input in developing operational plans and
26preparing the reports for the Illinois Health Benefits



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1Exchange Advisory Committee.
2    (c) The Illinois Health Benefits Exchange Advisory
3Committee shall include 9 members, as follows:
4        (1) The Director of Insurance, or the Director's
5    designee, who shall serve ex officio and as co-chair;
6        (2) The Director of Healthcare and Family Services, or
7    the Director's designee, who shall serve ex officio and as
8    co-chair;
9        (3) The Secretary of Human Services, or the
10    Secretary's designee, who shall serve ex officio; and
11        (4) 6 public members, who shall be residents of the
12    State, appointed by the Director of Insurance. The
13    Director shall consider the diversity of this State in the
14    selection of the committee members. Each public member
15    shall have demonstrated experience in one or more of the
16    following areas: health insurance consumer advocacy;
17    enrollment and consumer assistance; individual health
18    insurance coverage; providing health care services; or
19    academic or professional research relating to health
20    insurance.
21    (d) Members of the Illinois Health Benefits Exchange
22Advisory Committee shall serve for a term of 2 years, shall
23serve without compensation, and shall not be entitled to
24reimbursement. The Department of Insurance shall provide
25administrative support to the Illinois Health Benefits
26Exchange Advisory Committee.



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1    (e) The Committee's quarterly meetings shall be open to
2the public and subject to the Open Meetings Act.
3    Section 99. Effective date. This Act takes effect upon
4becoming law.".