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Public Act 103-0703


 

Public Act 0703 103RD GENERAL ASSEMBLY

 


 
Public Act 103-0703
 
HB5295 EnrolledLRB103 38679 RPS 68816 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Insurance Code is amended by
changing Section 356z.56 as follows:
 
    (215 ILCS 5/356z.56)
    Sec. 356z.56. Coverage for hormonal and non-hormonal
hormone therapy to treat menopause. A group or individual
policy of accident and health insurance or a managed care plan
that is amended, delivered, issued, or renewed in this State
on or after January 1, 2024 shall provide coverage for
medically necessary hormone therapy treatment to treat
menopause that has been induced by a hysterectomy. This
coverage applies only to coverage provided on or after January
1, 2024 and before January 1, 2026.
    A group or individual policy of accident and health
insurance or a managed care plan that is amended, delivered,
issued, or renewed on or after January 1, 2026 shall provide
coverage for medically necessary hormonal and non-hormonal
therapy to treat menopausal symptoms if the therapy is
recommended by a qualified health care provider who is
licensed, accredited, or certified under Illinois law and the
therapy has been proven safe and effective in peer-reviewed
scientific studies. Coverage for therapy to treat menopausal
symptoms shall include all federal Food and Drug
Administration-approved modalities of hormonal and
non-hormonal administration, including, but not limited to,
oral, transdermal, topical, and vaginal rings.
(Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23.)
 
    Section 10. The Illinois Public Aid Code is amended by
changing Section 5-16.8 and by adding Section 5-52 as follows:
 
    (305 ILCS 5/5-16.8)
    Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code,
(ii) be subject to the provisions of Sections 356z.19,
356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
Insurance Code, and (iii) be subject to the provisions of
subsection (d-5) of Section 10 of the Network Adequacy and
Transparency Act.
    The Department, by rule, shall adopt a model similar to
the requirements of Section 356z.39 of the Illinois Insurance
Code.
    On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.
    To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
 
    (305 ILCS 5/5-52 new)
    Sec. 5-52. Coverage for hormonal therapy to treat
menopause. The medical assistance program shall provide
coverage for medically necessary hormone therapy treatment to
treat menopause that has been induced by a hysterectomy.
 
    Section 99. Effective date. This Act takes effect January
1, 2026.

Effective Date: 1/1/2026