Full Text of SB3538 103rd General Assembly
SB3538ham001 103RD GENERAL ASSEMBLY | Rep. Angelica Guerrero-Cuellar Filed: 5/3/2024 | | 10300SB3538ham001 | | LRB103 36871 AWJ 72549 a |
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| 1 | | AMENDMENT TO SENATE BILL 3538
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 3538 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Counties Code is amended by changing | 5 | | Section 5-1069 as follows: | 6 | | (55 ILCS 5/5-1069) (from Ch. 34, par. 5-1069) | 7 | | Sec. 5-1069. Group life, health, accident, hospital, and | 8 | | medical insurance. | 9 | | (a) The county board of any county may arrange to provide, | 10 | | for the benefit of employees of the county, group life, | 11 | | health, accident, hospital, and medical insurance, or any one | 12 | | or any combination of those types of insurance, or the county | 13 | | board may self-insure, for the benefit of its employees, all | 14 | | or a portion of the employees' group life, health, accident, | 15 | | hospital, and medical insurance, or any one or any combination | 16 | | of those types of insurance, including a combination of |
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| 1 | | self-insurance and other types of insurance authorized by this | 2 | | Section, provided that the county board complies with all | 3 | | other requirements of this Section. The insurance may include | 4 | | provision for employees who rely on treatment by prayer or | 5 | | spiritual means alone for healing in accordance with the | 6 | | tenets and practice of a well recognized religious | 7 | | denomination. The county board may provide for payment by the | 8 | | county of a portion or all of the premium or charge for the | 9 | | insurance with the employee paying the balance of the premium | 10 | | or charge, if any. If the county board undertakes a plan under | 11 | | which the county pays only a portion of the premium or charge, | 12 | | the county board shall provide for withholding and deducting | 13 | | from the compensation of those employees who consent to join | 14 | | the plan the balance of the premium or charge for the | 15 | | insurance. | 16 | | (b) If the county board does not provide for | 17 | | self-insurance or for a plan under which the county pays a | 18 | | portion or all of the premium or charge for a group insurance | 19 | | plan, the county board may provide for withholding and | 20 | | deducting from the compensation of those employees who consent | 21 | | thereto the total premium or charge for any group life, | 22 | | health, accident, hospital, and medical insurance. | 23 | | (c) The county board may exercise the powers granted in | 24 | | this Section only if it provides for self-insurance or, where | 25 | | it makes arrangements to provide group insurance through an | 26 | | insurance carrier, if the kinds of group insurance are |
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| 1 | | obtained from an insurance company authorized to do business | 2 | | in the State of Illinois. The county board may enact an | 3 | | ordinance prescribing the method of operation of the insurance | 4 | | program. | 5 | | (d) If a county, including a home rule county, is a | 6 | | self-insurer for purposes of providing health insurance | 7 | | coverage for its employees, the insurance coverage shall | 8 | | include screening by low-dose mammography for all women 35 | 9 | | years of age or older for the presence of occult breast cancer | 10 | | unless the county elects to provide mammograms itself under | 11 | | Section 5-1069.1. The coverage shall be as follows: | 12 | | (1) A baseline mammogram for women 35 to 39 years of | 13 | | age. | 14 | | (2) An annual mammogram for women 40 years of age or | 15 | | older. | 16 | | (3) A mammogram at the age and intervals considered | 17 | | medically necessary by the woman's health care provider | 18 | | for women under 40 years of age and having a family history | 19 | | of breast cancer, prior personal history of breast cancer, | 20 | | positive genetic testing, or other risk factors. | 21 | | (4) For a group policy of accident and health | 22 | | insurance that is amended, delivered, issued, or renewed | 23 | | on or after the effective date of this amendatory Act of | 24 | | the 101st General Assembly, a comprehensive ultrasound | 25 | | screening of an entire breast or breasts if a mammogram | 26 | | demonstrates heterogeneous or dense breast tissue or when |
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| 1 | | medically necessary as determined by a physician licensed | 2 | | to practice medicine in all of its branches, advanced | 3 | | practice registered nurse, or physician assistant. | 4 | | (5) For a group policy of accident and health | 5 | | insurance that is amended, delivered, issued, or renewed | 6 | | on or after the effective date of this amendatory Act of | 7 | | the 101st General Assembly, a diagnostic mammogram when | 8 | | medically necessary, as determined by a physician licensed | 9 | | to practice medicine in all its branches, advanced | 10 | | practice registered nurse, or physician assistant. | 11 | | A policy subject to this subsection shall not impose a | 12 | | deductible, coinsurance, copayment, or any other cost-sharing | 13 | | requirement on the coverage provided; except that this | 14 | | sentence does not apply to coverage of diagnostic mammograms | 15 | | to the extent such coverage would disqualify a high-deductible | 16 | | health plan from eligibility for a health savings account | 17 | | pursuant to Section 223 of the Internal Revenue Code (26 | 18 | | U.S.C. 223). | 19 | | For purposes of this subsection: | 20 | | "Diagnostic mammogram" means a mammogram obtained using | 21 | | diagnostic mammography. | 22 | | "Diagnostic mammography" means a method of screening that | 23 | | is designed to evaluate an abnormality in a breast, including | 24 | | an abnormality seen or suspected on a screening mammogram or a | 25 | | subjective or objective abnormality otherwise detected in the | 26 | | breast. |
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| 1 | | "Low-dose mammography" means the x-ray examination of the | 2 | | breast using equipment dedicated specifically for mammography, | 3 | | including the x-ray tube, filter, compression device, and | 4 | | image receptor, with an average radiation exposure delivery of | 5 | | less than one rad per breast for 2 views of an average size | 6 | | breast. The term also includes digital mammography. | 7 | | (d-5) Coverage as described by subsection (d) shall be | 8 | | provided at no cost to the insured and shall not be applied to | 9 | | an annual or lifetime maximum benefit. | 10 | | (d-10) When health care services are available through | 11 | | contracted providers and a person does not comply with plan | 12 | | provisions specific to the use of contracted providers, the | 13 | | requirements of subsection (d-5) are not applicable. When a | 14 | | person does not comply with plan provisions specific to the | 15 | | use of contracted providers, plan provisions specific to the | 16 | | use of non-contracted providers must be applied without | 17 | | distinction for coverage required by this Section and shall be | 18 | | at least as favorable as for other radiological examinations | 19 | | covered by the policy or contract. | 20 | | (d-15) If a county, including a home rule county, is a | 21 | | self-insurer for purposes of providing health insurance | 22 | | coverage for its employees, the insurance coverage shall | 23 | | include mastectomy coverage, which includes coverage for | 24 | | prosthetic devices or reconstructive surgery incident to the | 25 | | mastectomy. Coverage for breast reconstruction in connection | 26 | | with a mastectomy shall include: |
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| 1 | | (1) reconstruction of the breast upon which the | 2 | | mastectomy has been performed; | 3 | | (2) surgery and reconstruction of the other breast to | 4 | | produce a symmetrical appearance; and | 5 | | (3) prostheses and treatment for physical | 6 | | complications at all stages of mastectomy, including | 7 | | lymphedemas. | 8 | | Care shall be determined in consultation with the attending | 9 | | physician and the patient. The offered coverage for prosthetic | 10 | | devices and reconstructive surgery shall be subject to the | 11 | | deductible and coinsurance conditions applied to the | 12 | | mastectomy, and all other terms and conditions applicable to | 13 | | other benefits. When a mastectomy is performed and there is no | 14 | | evidence of malignancy then the offered coverage may be | 15 | | limited to the provision of prosthetic devices and | 16 | | reconstructive surgery to within 2 years after the date of the | 17 | | mastectomy. As used in this Section, "mastectomy" means the | 18 | | removal of all or part of the breast for medically necessary | 19 | | reasons, as determined by a licensed physician. | 20 | | A county, including a home rule county, that is a | 21 | | self-insurer for purposes of providing health insurance | 22 | | coverage for its employees, may not penalize or reduce or | 23 | | limit the reimbursement of an attending provider or provide | 24 | | incentives (monetary or otherwise) to an attending provider to | 25 | | induce the provider to provide care to an insured in a manner | 26 | | inconsistent with this Section. |
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| 1 | | (d-20) The requirement that mammograms be included in | 2 | | health insurance coverage as provided in subsections (d) | 3 | | through (d-15) is an exclusive power and function of the State | 4 | | and is a denial and limitation under Article VII, Section 6, | 5 | | subsection (h) of the Illinois Constitution of home rule | 6 | | county powers. A home rule county to which subsections (d) | 7 | | through (d-15) apply must comply with every provision of those | 8 | | subsections. | 9 | | (e) The term "employees" as used in this Section includes | 10 | | elected or appointed officials but does not include temporary | 11 | | employees. | 12 | | (f) The county board may, by ordinance, arrange to provide | 13 | | group life, health, accident, hospital, and medical insurance, | 14 | | or any one or a combination of those types of insurance, under | 15 | | this Section to retired former employees and retired former | 16 | | elected or appointed officials of the county. | 17 | | (g) Rulemaking authority to implement this amendatory Act | 18 | | of the 95th General Assembly, if any, is conditioned on the | 19 | | rules being adopted in accordance with all provisions of the | 20 | | Illinois Administrative Procedure Act and all rules and | 21 | | procedures of the Joint Committee on Administrative Rules; any | 22 | | purported rule not so adopted, for whatever reason, is | 23 | | unauthorized. | 24 | | (h) If a county, including a home rule county, is a | 25 | | self-insurer for purposes of providing health insurance | 26 | | coverage for its employees, the insurance coverage shall |
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| 1 | | include, on and after June 1, 2025, mental health counseling | 2 | | for any county employee who is a first responder without | 3 | | imposing a deductible, coinsurance, copayment, or any other | 4 | | cost-sharing requirement on the coverage provided, except that | 5 | | this subsection does not apply to the extent such coverage | 6 | | would disqualify a high-deductible health plan from | 7 | | eligibility for a health savings account pursuant to Section | 8 | | 223 of the Internal Revenue Code. | 9 | | The requirement that mental health counseling be included | 10 | | in health insurance coverage as provided in this subsection is | 11 | | an exclusive power and function of the State and is a denial | 12 | | and limitation under Article VII, Section 6, subsection (h) of | 13 | | the Illinois Constitution of home rule county powers. | 14 | | As used in this subsection: | 15 | | "First responders" means police and corrections officers, | 16 | | deputy sheriffs, firefighters, emergency medical services | 17 | | personnel, as that term is defined in Section 3.5 of the | 18 | | Emergency Medical Services (EMS) Systems Act, dispatched | 19 | | pursuant to a 9-1-1 call, emergency medical dispatchers, as | 20 | | that term is defined in Section 3.70 of the Emergency Medical | 21 | | Services (EMS) Systems Act, public safety telecommunicators, | 22 | | as that term is defined in Section 2 of the Emergency Telephone | 23 | | System Act, and mental health professionals employed and | 24 | | dispatched by any unit of local government in response to | 25 | | emergency crisis calls received on public emergency service | 26 | | lines instead of or in conjunction with law enforcement. |
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| 1 | | "Mental health counseling" means counseling therapy | 2 | | sessions provided by a clinical social worker, professional | 3 | | counselor, or licensed psychologist. | 4 | | (Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20 .) | 5 | | Section 10. The Illinois Municipal Code is amended by | 6 | | adding Section 10-4-2.4 as follows: | 7 | | (65 ILCS 5/10-4-2.4 new) | 8 | | Sec. 10-4-2.4. Mental health counseling. | 9 | | (a) As used in this Section: | 10 | | "First responders" means police and corrections officers, | 11 | | deputy sheriffs, firefighters, emergency medical services | 12 | | personnel, as that term is defined in Section 3.5 of the | 13 | | Emergency Medical Services (EMS) Systems Act, dispatched | 14 | | pursuant to a 9-1-1 call, emergency medical dispatchers, as | 15 | | that term is defined in Section 3.70 of the Emergency Medical | 16 | | Services (EMS) Systems Act, public safety telecommunicators, | 17 | | as that term is defined in Section 2 of the Emergency Telephone | 18 | | System Act, and mental health professionals employed and | 19 | | dispatched by any unit of local government in response to | 20 | | emergency crisis calls received on public emergency service | 21 | | lines instead of or in conjunction with law enforcement. | 22 | | "Mental health counseling" means counseling therapy | 23 | | sessions provided by a clinical social worker, professional | 24 | | counselor, or licensed psychologist. |
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| 1 | | (b) If a municipality, including a home rule municipality, | 2 | | is a self-insurer for purposes of providing health insurance | 3 | | coverage for its employees, the insurance coverage shall | 4 | | include, on and after June 1, 2025, mental health counseling | 5 | | for any employee who is a first responder without imposing a | 6 | | deductible, coinsurance, copayment, or any other cost-sharing | 7 | | requirement on the coverage provided, except that this Section | 8 | | does not apply to the extent such coverage would disqualify a | 9 | | high-deductible health plan from eligibility for a health | 10 | | savings account pursuant to Section 223 of the Internal | 11 | | Revenue Code. | 12 | | (c) The requirement that mental health counseling be | 13 | | included in health insurance coverage as provided in this | 14 | | Section is an exclusive power and function of the State and is | 15 | | a denial and limitation under Article VII, Section 6, | 16 | | subsection (h) of the Illinois Constitution of home rule | 17 | | powers. ". |
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