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Public Act 102-0034


 

Public Act 0034 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0034
 
SB1096 EnrolledLRB102 04919 CPF 14938 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
adding Section 356z.43 as follows:
 
    (215 ILCS 5/356z.43 new)
    Sec. 356z.43. Coverage for COVID-19 diagnostic testing for
nursing home employees.
    (a) As used in this Section:
    "COVID-19" means the disease caused by SARS-CoV-2 or any
further mutation.
    "Department" means the Department of Public Health.
    "Diagnostic testing" means testing administered for the
purposes of diagnosing COVID-19 or a related virus and the
administration of such tests if the test is:
        (1) approved, cleared, or authorized under Section
    510(k), 513, 515, or 564 of the Federal Food, Drug, and
    Cosmetic Act (21 U.S.C. 360(k), 360c, 360e, and 360bbb-3);
        (2) the subject of a request or intended request for
    emergency use authorization under Section 564 of the
    Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-3)
    until the emergency use authorization request has been
    denied or the developer of the test does not submit a
    request within a reasonable timeframe;
        (3) developed and authorized by a state that has
    notified the Secretary of the United States Department of
    Health and Human Services of its intention to review a
    test intended to diagnose COVID-19; or
        (4) determined by the Secretary of the United States
    Department of Health and Human Services or the Director of
    the Centers for Disease Control and Prevention as
    appropriate for the diagnosis of COVID-19.
    "Enrollee" means a long-term care facility employee who is
covered by a health plan.
    "Health plan" means (i) individual health insurance
coverage, as defined in Section 5 of the Illinois Health
Insurance Portability and Accountability Act, and (ii) group
health insurance coverage, as defined in Section 5 of the
Illinois Health Insurance Portability and Accountability Act
for employees of a licensed long-term care facility.
    "Long-term care facility" means a long-term care facility
as defined in Section 1-113 of the Nursing Home Care Act, an
assisted living establishment as defined in Section 10 of the
Assisted Living and Shared Housing Act, a MC/DD facility as
defined in Section 1-113 of the MC/DD Act, an ID/DD facility as
defined in Section 1-113 of the ID/DD Community Care Act, a
facility as defined in Section 1-102 of the Specialized Mental
Health Rehabilitation Act of 2013, or a supportive living
facility as defined in Section 5.01a of the Illinois Public
Aid Code.
    "Testing provider" means a provider that is authorized by
the Department of Public Health to perform diagnostic testing
for licensed long-term care facilities.
    (b) A health plan amended, delivered, issued, or renewed
on or after the effective date of this amendatory Act of the
102nd General Assembly shall provide coverage of diagnostic
testing for enrollees that is performed by a testing provider
in accordance with federal COVID-19 testing requirements as
set forth in subsection (h) of 42 CFR 483.80; emergency rules
adopted by the Department in 77 Ill. Adm. Code 295.4045,
300.696, 330.340, 350.760, and 390.340; and applicable federal
and Department guidance.
    (c) Testing performed in accordance with subsection (b)
shall be considered medically necessary for the purposes of
this Section.
    (d) A health plan may inquire as to whether an enrollee is
an employee of the long-term care facility but shall not
require further evidence or verification of the enrollee's
employment status.
    (e) The coverage requirements set forth in this Section
shall only apply when the testing requirements set forth in
subsection (b) are in effect.
    (f) Any failure to provide coverage pursuant to this
Section shall be deemed a failure to substantially comply with
this Code.
    (g) This Section is repealed on January 1, 2022.
 
    Section 10. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
 
    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
    Sec. 5-3. Insurance Code provisions.
    (a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
Insurance Code.
    (b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
        (1) a corporation authorized under the Dental Service
    Plan Act or the Voluntary Health Services Plans Act;
        (2) a corporation organized under the laws of this
    State; or
        (3) a corporation organized under the laws of another
    state, 30% or more of the enrollees of which are residents
    of this State, except a corporation subject to
    substantially the same requirements in its state of
    organization as is a "domestic company" under Article VIII
    1/2 of the Illinois Insurance Code.
    (c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
        (1) the Director shall give primary consideration to
    the continuation of benefits to enrollees and the
    financial conditions of the acquired Health Maintenance
    Organization after the merger, consolidation, or other
    acquisition of control takes effect;
        (2)(i) the criteria specified in subsection (1)(b) of
    Section 131.8 of the Illinois Insurance Code shall not
    apply and (ii) the Director, in making his determination
    with respect to the merger, consolidation, or other
    acquisition of control, need not take into account the
    effect on competition of the merger, consolidation, or
    other acquisition of control;
        (3) the Director shall have the power to require the
    following information:
            (A) certification by an independent actuary of the
        adequacy of the reserves of the Health Maintenance
        Organization sought to be acquired;
            (B) pro forma financial statements reflecting the
        combined balance sheets of the acquiring company and
        the Health Maintenance Organization sought to be
        acquired as of the end of the preceding year and as of
        a date 90 days prior to the acquisition, as well as pro
        forma financial statements reflecting projected
        combined operation for a period of 2 years;
            (C) a pro forma business plan detailing an
        acquiring party's plans with respect to the operation
        of the Health Maintenance Organization sought to be
        acquired for a period of not less than 3 years; and
            (D) such other information as the Director shall
        require.
    (d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including without limitation the health
maintenance organization's right, title, and interest in and
to its health care certificates).
    (e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
    (f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
        (i) the amount of, and other terms and conditions with
    respect to, the refund or additional premium are set forth
    in the group or enrollment unit contract agreed in advance
    of the period for which a refund is to be paid or
    additional premium is to be charged (which period shall
    not be less than one year); and
        (ii) the amount of the refund or additional premium
    shall not exceed 20% of the Health Maintenance
    Organization's profitable or unprofitable experience with
    respect to the group or other enrollment unit for the
    period (and, for purposes of a refund or additional
    premium, the profitable or unprofitable experience shall
    be calculated taking into account a pro rata share of the
    Health Maintenance Organization's administrative and
    marketing expenses, but shall not include any refund to be
    made or additional premium to be paid pursuant to this
    subsection (f)). The Health Maintenance Organization and
    the group or enrollment unit may agree that the profitable
    or unprofitable experience may be calculated taking into
    account the refund period and the immediately preceding 2
    plan years.
    The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or
enrollment unit.
    In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
    (g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
1-1-20; 101-625, eff. 1-1-21.)
 
    (215 ILCS 195/Act rep.)
    Section 15. The COVID-19 Medically Necessary Diagnostic
Testing Act is repealed.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 6/25/2021