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91_HB0154
LRB9100692JSpc
1 AN ACT concerning cancer, amending named Acts.
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
5 1971 is amended by changing Section 6.11 as follows:
6 (5 ILCS 375/6.11)
7 Sec. 6.11. Required health benefits. The program of
8 health benefits shall provide the post-mastectomy care
9 benefits required to be covered by a policy of accident and
10 health insurance under Section 356t of the Illinois Insurance
11 Code. The program of health benefits shall provide the
12 coverage required under Sections 356u, 356w, and 356x, 356y,
13 and 356z of the Illinois Insurance Code.
14 (Source: P.A. 90-7, eff. 6-10-97; 90-655, eff. 7-30-98;
15 90-741, eff. 1-1-99.)
16 Section 10. The Civil Administrative Code of Illinois is
17 amended by changing Section 55.70 and adding Section 55.91 as
18 follows:
19 (20 ILCS 2310/55.70)
20 Sec. 55.70. Breast, and Cervical, and Prostate Cancer
21 Research Fund. From funds appropriated from the Breast, and
22 Cervical, and Prostate Cancer Research Fund, the Department
23 of Public Health shall award grants to eligible physicians,
24 hospitals, laboratories, education institutions, and other
25 organizations and persons to enable organizations and persons
26 to conduct research. For the purposes of this Section,
27 "research" includes, but is not limited to, expenditures to
28 develop and advance the understanding, techniques, and
29 modalities effective in early detection, prevention, cure,
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1 screening, and treatment of breast, and cervical, and
2 prostate cancer and may include clinical trials.
3 Moneys received for the purposes of this Section,
4 including but not limited to income tax checkoff receipts and
5 gifts, grants, and awards from private foundations, nonprofit
6 organizations, other governmental entities and persons shall
7 be deposited into the Breast and Cervical Cancer Research
8 Fund, which is hereby created as a special fund in the State
9 treasury.
10 The Department of Public Health shall create an advisory
11 committee with members from, but not limited to, the Illinois
12 Chapter of the American Cancer Society, Y-Me, and the State
13 Board of Health for the purpose of awarding research grants
14 under this Section. Members of the advisory committee shall
15 not be eligible for any financial compensation or
16 reimbursement.
17 (Source: P.A. 88-85; 88-459; 88-670, eff. 12-2-94.)
18 (20 ILCS 2310/55.91 new)
19 Sec. 55.91. Breast Cancer Treatment Advisory Committee.
20 (a) The Breast Cancer Treatment Advisory Committee is
21 hereby created. The Committee shall be composed of the
22 following members:
23 (1) 8 members of the General Assembly, 2 each
24 appointed by the Speaker of the House, the President of
25 the Senate, the Minority Leader of the House, and the
26 Minority Leader of the Senate; and
27 (2) 8 members who have knowledge of breast cancer
28 treatment procedures, 2 each appointed by the Speaker of
29 the House, the President of the Senate, the Minority
30 Leader of the House, and the Minority Leader of the
31 Senate.
32 (b) Members of the committee shall serve for a term that
33 ends on the expiration of the General Assembly during which
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1 they were appointed. Members of the committee who are not
2 members of the General Assembly shall receive a per diem of
3 $150 for each day of attendance at committee meetings. The
4 Speaker of the House and the President of the Senate shall
5 each designate one member of the committee to serve as
6 co-chairperson of the committee. The committee shall meet at
7 the times and places designated by the co-chairpersons.
8 (c) The committee shall review and study techniques and
9 modalities effective in the prevention, detection, treatment,
10 or cure of breast cancer and make recommendations to the
11 General Assembly of legislation necessary or desirable to
12 improve treatment of breast cancer.
13 (d) The Department of Public Health shall provide
14 necessary staff support to perform the functions of the
15 committee, including the preparation of its recommendations
16 to the General Assembly.
17 Section 15. The State Finance Act is amended by changing
18 Section 5.362 as follows:
19 (30 ILCS 105/5.362)
20 Sec. 5.362. The Breast, and Cervical, and Prostate Cancer
21 Research Fund.
22 (Source: P.A. 88-85; 88-459; 88-670, eff. 12-2-94; 89-235,
23 eff. 8-4-95.)
24 Section 20. The State Mandates Act is amended by adding
25 Section 8.23 as follows:
26 (30 ILCS 805/8.23 new)
27 Sec. 8.23. Exempt mandate. Notwithstanding Sections 6
28 and 8 of this Act, no reimbursement by the State is required
29 for the implementation of any mandate created by this
30 amendatory Act of 1999.
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1 Section 25. The Illinois Income Tax Act is amended by
2 changing Sections 507L, 509, and 510 as follows:
3 (35 ILCS 5/507L)
4 Sec. 507L. Breast, and Cervical, and Prostate Cancer
5 Research Fund checkoff. Beginning with taxable years ending
6 on December 31, 1993, the Department shall print on its
7 standard individual income tax form a provision indicating
8 that if the taxpayer wishes to contribute to the Breast, and
9 Cervical, and Prostate Cancer Research Fund as authorized by
10 Public Acts 88-85 and 88-459, he or she may do so by stating
11 the amount of the contribution (not less than $1) on the
12 return and that the contribution will reduce the taxpayer's
13 refund or increase the amount of the payment to accompany the
14 return. Failure to remit any amount of increased payment
15 shall reduce the contribution accordingly. This Section
16 shall not apply to an amended return.
17 (Source: P.A. 88-85; 88-459; 88-670, eff. 12-2-94.)
18 (35 ILCS 5/509) (from Ch. 120, par. 5-509)
19 Sec. 509. Tax checkoff explanations. All individual
20 income tax return forms shall contain appropriate
21 explanations and spaces to enable the taxpayers to designate
22 contributions to the Child Abuse Prevention Fund, to the
23 Community Health Center Care Fund, to the Illinois Wildlife
24 Preservation Fund as required by the Illinois Non-Game
25 Wildlife Protection Act, to the Alzheimer's Disease Research
26 Fund as required by the Alzheimer's Disease Research Act, to
27 the Assistance to the Homeless Fund as required by this Act,
28 to the Heritage Preservation Fund as required by the Heritage
29 Preservation Act, to the Child Care Expansion Program Fund as
30 required by the Child Care Expansion Program Act, to the Ryan
31 White AIDS Victims Assistance Fund, to the Assistive
32 Technology for Persons with Disabilities Fund, to the
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1 Domestic Violence Shelter and Service Fund, to the United
2 States Olympians Assistance Fund, to the Youth Drug Abuse
3 Prevention Fund, to the Persian Gulf Conflict Veterans Fund,
4 to the Literacy Advancement Fund, to the Ryan White Pediatric
5 and Adult AIDS Fund, to the Illinois Special Olympics
6 Checkoff Fund, to the Breast, and Cervical, and Prostate
7 Cancer Research Fund, to the Korean War Memorial Fund, to the
8 Heart Disease Treatment and Prevention Fund, to the
9 Hemophilia Treatment Fund, to the Mental Health Research
10 Fund, to the Children's Cancer Fund, to the American Diabetes
11 Association Fund, the Women in Military Service Memorial
12 Fund, and to the Meals on Wheels Fund. Each form shall
13 contain a statement that the contributions will reduce the
14 taxpayer's refund or increase the amount of payment to
15 accompany the return. Failure to remit any amount of
16 increased payment shall reduce the contribution accordingly.
17 If, on October 1 of any year, the total contributions to
18 any one of the funds, other than the Breast, Cervical, and
19 Prostate Cancer Research Fund, made under this Section do not
20 equal $100,000 or more, the explanations and spaces for
21 designating contributions to the fund shall be removed from
22 the individual income tax return forms for the following and
23 all subsequent years and all subsequent contributions to the
24 fund shall be refunded to the taxpayer. If, on October 1,
25 2004 or any year thereafter, the total contributions to the
26 Breast, Cervical, and Prostate Cancer Research Fund made
27 under this Section do not equal $100,000 or more, the
28 explanations and spaces for designating contributions to the
29 fund shall be removed from the individual income tax return
30 forms for the following and all subsequent years and all
31 subsequent contributions to the fund shall be refunded to the
32 taxpayer.
33 (Source: P.A. 89-230, eff. 1-1-96; 89-324, eff. 8-13-95;
34 90-171, eff. 7-23-97.)
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1 (35 ILCS 5/510) (from Ch. 120, par. 5-510)
2 Sec. 510. Determination of amounts contributed. The
3 Department shall determine the total amount contributed to
4 each of the following: the Child Abuse Prevention Fund, the
5 Illinois Wildlife Preservation Fund, the Community Health
6 Center Care Fund, the Assistance to the Homeless Fund, the
7 Alzheimer's Disease Research Fund, the Heritage Preservation
8 Fund, the Child Care Expansion Program Fund, the Ryan White
9 AIDS Victims Assistance Fund, the Assistive Technology for
10 Persons with Disabilities Fund, the Domestic Violence Shelter
11 and Service Fund, the United States Olympians Assistance
12 Fund, the Youth Drug Abuse Prevention Fund, the Persian Gulf
13 Conflict Veterans Fund, the Literacy Advancement Fund, the
14 Ryan White Pediatric and Adult AIDS Fund, the Illinois
15 Special Olympics Checkoff Fund, the Breast, and Cervical, and
16 Prostate Cancer Research Fund, the Korean War Memorial Fund,
17 the Heart Disease Treatment and Prevention Fund, the
18 Hemophilia Treatment Fund, the Mental Health Research Fund,
19 the Children's Cancer Fund, the American Diabetes
20 Association Fund, the Women in Military Service Memorial
21 Fund, and the Meals on Wheels Fund; and shall notify the
22 State Comptroller and the State Treasurer of the amounts to
23 be transferred from the General Revenue Fund to each fund,
24 and upon receipt of such notification the State Treasurer and
25 Comptroller shall transfer the amounts.
26 (Source: P.A. 89-230, eff. 1-1-96; 89-324, eff. 8-13-95;
27 90-171, eff. 7-23-97.)
28 Section 30. The Counties Code is amended by changing
29 Section 5-1069.3 as follows:
30 (55 ILCS 5/5-1069.3)
31 Sec. 5-1069.3. Required health benefits. If a county,
32 including a home rule county, is a self-insurer for purposes
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1 of providing health insurance coverage for its employees, the
2 coverage shall include coverage for the post-mastectomy care
3 benefits required to be covered by a policy of accident and
4 health insurance under Section 356t and the coverage required
5 under Sections 356u, 356w, and 356x, 356y, and 356z of the
6 Illinois Insurance Code. The requirement that health
7 benefits be covered as provided in this Section is an
8 exclusive power and function of the State and is a denial and
9 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 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
14 Section 35. The Illinois Municipal Code is amended by
15 changing Section 10-4-2.3 as follows:
16 (65 ILCS 5/10-4-2.3)
17 Sec. 10-4-2.3. Required health benefits. If a
18 municipality, including a home rule municipality, is a
19 self-insurer for purposes of providing health insurance
20 coverage for its employees, the coverage shall include
21 coverage for the post-mastectomy care benefits required to be
22 covered by a policy of accident and health insurance under
23 Section 356t and the coverage required under Sections 356u,
24 356w, and 356x, 356y, and 356z of the Illinois Insurance
25 Code. The requirement that health benefits be covered as
26 provided in this is an exclusive power and function of the
27 State and is a denial and limitation under Article VII,
28 Section 6, subsection (h) of the Illinois Constitution. A
29 home rule municipality to which this Section applies must
30 comply with every provision of this Section.
31 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
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1 Section 40. The School Code is amended by changing
2 Section 10-22.3f as follows:
3 (105 ILCS 5/10-22.3f)
4 Sec. 10-22.3f. Required health benefits. Insurance
5 protection and benefits for employees shall provide the
6 post-mastectomy care benefits required to be covered by a
7 policy of accident and health insurance under Section 356t
8 and the coverage required under Sections 356u, 356w, and 356x
9 , 356y, and 356z of the Illinois Insurance Code.
10 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
11 Section 45. The Illinois Insurance Code is amended by
12 adding Sections 356y and 356z as follows:
13 (215 ILCS 5/356y new)
14 Sec. 356y. Breast cancer treatments. An individual or
15 group policy of accident and health insurance or managed care
16 plan that provides coverage for hospital or medical treatment
17 or services for illness and is amended, delivered, issued, or
18 renewed after the effective date of this amendatory Act of
19 1999 must provide coverage for:
20 (1) all drugs approved by the federal Food and Drug
21 Administration that are used for the treatment or
22 prevention of breast cancer;
23 (2) all nutritional therapies, dietary supplements,
24 and dietary therapies prescribed by a physician licensed
25 to practice medicine and of its branches for treatment or
26 prevention of breast cancer; and
27 (3) the computer-aided diagnosis of breast cancer
28 when the diagnostic services are performed pursuant to a
29 mammography and are requested or recommended by a
30 physician licensed to practice medicine in all of its
31 branches.
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1 (215 ILCS 5/356z new)
2 Sec. 356z. Coverage for investigational cancer
3 treatments.
4 (a) An individual or group policy of accident and health
5 insurance issued, delivered, amended, or renewed in this
6 State after the effective date of this amendatory Act of 1999
7 must provide coverage for patient care of insureds, when
8 medically appropriate, to participate in an approved research
9 trial and shall provide coverage for the patient care
10 provided pursuant to investigational cancer treatments as
11 provided in subsection (b).
12 (b) Coverage must be included for an item or service
13 that would otherwise be covered, subject to the limitations
14 and cost sharing requirements applicable to the item or
15 service, when that item or service is provided to an insured
16 in the course of an investigational cancer treatment if:
17 (1) the treatment is a qualifying cancer
18 investigational treatment; and
19 (2) the cancer treatment is administered as part of
20 the medical management of a life-threatening disease,
21 disorder, or health condition.
22 Coverage must be included for an item or service when
23 that item or service is required to provide patient care
24 pursuant to the design of a research trial, except those
25 items or services normally paid for by other funding sources,
26 such as the costs of certain investigational agents, the
27 costs of any nonhealth services that might be required for a
28 person to receive cancer treatment, and the costs of managing
29 the research; items or services subject to this exception may
30 be covered in addition to patient care at the discretion of
31 the health plan.
32 (c) For purposes of this Section, (A) "qualifying
33 investigational cancer treatment" means a treatment (i) the
34 effectiveness of which has not been determined and (ii) that
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1 is under clinical investigation as part of an approved cancer
2 research trial and (B) "approved cancer research trial" means
3 (i) a cancer research trial approved by the U.S. Secretary of
4 Health and Human Services, the Director of the National
5 Institutes of Health, the Commissioner of the Food and Drug
6 Administration (through an investigational new drug exemption
7 under Section 505(1) of the federal Food, Drug and Cosmetic
8 Act or an investigational device exemption under Section
9 520(g) of that Act), the Secretary of Veterans Affairs, the
10 Secretary of Defense, or a qualified nongovernmental cancer
11 research entity as defined in guidelines of the National
12 Institutes of Health or (ii) a peer-reviewed and approved
13 cancer research program, as defined by the U.S. Secretary of
14 Health and Human Services, conducted for the primary purpose
15 of determining whether or not a cancer treatment is safe or
16 efficacious or has any other characteristic of a cancer
17 treatment that must be demonstrated in order for the cancer
18 treatment to be medically necessary or appropriate.
19 Section 50. The Health Maintenance Organization Act is
20 amended by changing Section 5-3 as follows:
21 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
22 Sec. 5-3. Insurance Code provisions.
23 (a) Health Maintenance Organizations shall be subject to
24 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
25 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
26 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x,
27 356y, 356z, 367i, 401, 401.1, 402, 403, 403A, 408, 408.2,
28 409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
29 Section 367, and Articles VIII 1/2, XII, XII 1/2, XIII, XIII
30 1/2, XXV, and XXVI of the Illinois Insurance Code.
31 (b) For purposes of the Illinois Insurance Code, except
32 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
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1 Health Maintenance Organizations in the following categories
2 are deemed to be "domestic companies":
3 (1) a corporation authorized under the Dental
4 Service Plan Act or the Voluntary Health Services Plans
5 Act;
6 (2) a corporation organized under the laws of this
7 State; or
8 (3) a corporation organized under the laws of
9 another state, 30% or more of the enrollees of which are
10 residents of this State, except a corporation subject to
11 substantially the same requirements in its state of
12 organization as is a "domestic company" under Article
13 VIII 1/2 of the Illinois Insurance Code.
14 (c) In considering the merger, consolidation, or other
15 acquisition of control of a Health Maintenance Organization
16 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
17 (1) the Director shall give primary consideration
18 to the continuation of benefits to enrollees and the
19 financial conditions of the acquired Health Maintenance
20 Organization after the merger, consolidation, or other
21 acquisition of control takes effect;
22 (2)(i) the criteria specified in subsection (1)(b)
23 of Section 131.8 of the Illinois Insurance Code shall not
24 apply and (ii) the Director, in making his determination
25 with respect to the merger, consolidation, or other
26 acquisition of control, need not take into account the
27 effect on competition of the merger, consolidation, or
28 other acquisition of control;
29 (3) the Director shall have the power to require
30 the following information:
31 (A) certification by an independent actuary of
32 the adequacy of the reserves of the Health
33 Maintenance Organization sought to be acquired;
34 (B) pro forma financial statements reflecting
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1 the combined balance sheets of the acquiring company
2 and the Health Maintenance Organization sought to be
3 acquired as of the end of the preceding year and as
4 of a date 90 days prior to the acquisition, as well
5 as pro forma financial statements reflecting
6 projected combined operation for a period of 2
7 years;
8 (C) a pro forma business plan detailing an
9 acquiring party's plans with respect to the
10 operation of the Health Maintenance Organization
11 sought to be acquired for a period of not less than
12 3 years; and
13 (D) such other information as the Director
14 shall require.
15 (d) The provisions of Article VIII 1/2 of the Illinois
16 Insurance Code and this Section 5-3 shall apply to the sale
17 by any health maintenance organization of greater than 10% of
18 its enrollee population (including without limitation the
19 health maintenance organization's right, title, and interest
20 in and to its health care certificates).
21 (e) In considering any management contract or service
22 agreement subject to Section 141.1 of the Illinois Insurance
23 Code, the Director (i) shall, in addition to the criteria
24 specified in Section 141.2 of the Illinois Insurance Code,
25 take into account the effect of the management contract or
26 service agreement on the continuation of benefits to
27 enrollees and the financial condition of the health
28 maintenance organization to be managed or serviced, and (ii)
29 need not take into account the effect of the management
30 contract or service agreement on competition.
31 (f) Except for small employer groups as defined in the
32 Small Employer Rating, Renewability and Portability Health
33 Insurance Act and except for medicare supplement policies as
34 defined in Section 363 of the Illinois Insurance Code, a
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1 Health Maintenance Organization may by contract agree with a
2 group or other enrollment unit to effect refunds or charge
3 additional premiums under the following terms and conditions:
4 (i) the amount of, and other terms and conditions
5 with respect to, the refund or additional premium are set
6 forth in the group or enrollment unit contract agreed in
7 advance of the period for which a refund is to be paid or
8 additional premium is to be charged (which period shall
9 not be less than one year); and
10 (ii) the amount of the refund or additional premium
11 shall not exceed 20% of the Health Maintenance
12 Organization's profitable or unprofitable experience with
13 respect to the group or other enrollment unit for the
14 period (and, for purposes of a refund or additional
15 premium, the profitable or unprofitable experience shall
16 be calculated taking into account a pro rata share of the
17 Health Maintenance Organization's administrative and
18 marketing expenses, but shall not include any refund to
19 be made or additional premium to be paid pursuant to this
20 subsection (f)). The Health Maintenance Organization and
21 the group or enrollment unit may agree that the
22 profitable or unprofitable experience may be calculated
23 taking into account the refund period and the immediately
24 preceding 2 plan years.
25 The Health Maintenance Organization shall include a
26 statement in the evidence of coverage issued to each enrollee
27 describing the possibility of a refund or additional premium,
28 and upon request of any group or enrollment unit, provide to
29 the group or enrollment unit a description of the method used
30 to calculate (1) the Health Maintenance Organization's
31 profitable experience with respect to the group or enrollment
32 unit and the resulting refund to the group or enrollment unit
33 or (2) the Health Maintenance Organization's unprofitable
34 experience with respect to the group or enrollment unit and
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1 the resulting additional premium to be paid by the group or
2 enrollment unit.
3 In no event shall the Illinois Health Maintenance
4 Organization Guaranty Association be liable to pay any
5 contractual obligation of an insolvent organization to pay
6 any refund authorized under this Section.
7 (Source: P.A. 89-90, eff. 6-30-95; 90-25, eff. 1-1-98;
8 90-177, eff. 7-23-97; 90-372, eff. 7-1-98; 90-583, eff.
9 5-29-98; 90-655, eff. 7-30-98; 90-741, eff. 1-1-99; revised
10 9-8-98.)
11 Section 55. The Voluntary Health Services Plans Act is
12 amended by changing Section 10 as follows:
13 (215 ILCS 165/10) (from Ch. 32, par. 604)
14 Sec. 10. Application of Insurance Code provisions.
15 Health services plan corporations and all persons interested
16 therein or dealing therewith shall be subject to the
17 provisions of Article XII 1/2 and Sections 3.1, 133, 140,
18 143, 143c, 149, 354, 355.2, 356r, 356t, 356u, 356v, 356w,
19 356x, 356y, 356z, 367.2, 401, 401.1, 402, 403, 403A, 408,
20 408.2, and 412, and paragraphs (7) and (15) of Section 367 of
21 the Illinois Insurance Code.
22 (Source: P.A. 89-514, eff. 7-17-96; 90-7, eff. 6-10-97;
23 90-25, eff. 1-1-98; 90-655, eff. 7-30-98; 90-741, eff.
24 1-1-99.)
25 Section 99. Effective date. This Act takes effect upon
26 becoming law.
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1 INDEX
2 Statutes amended in order of appearance
3 5 ILCS 375/6.11
4 20 ILCS 2310/55.70
5 20 ILCS 2310/55.91 new
6 30 ILCS 105/5.362
7 30 ILCS 805/8.22 new
8 35 ILCS 5/507L
9 35 ILCS 5/509 from Ch. 120, par. 5-509
10 35 ILCS 5/510 from Ch. 120, par. 5-510
11 55 ILCS 5/5-1069.3
12 65 ILCS 5/10-4-2.3
13 105 ILCS 5/10-22.3f
14 215 ILCS 5/356y new
15 215 ILCS 5/356z new
16 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
17 215 ILCS 165/10 from Ch. 32, par. 604