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Public Act 102-0804
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| HB5254 Enrolled | LRB102 25494 BMS 34782 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 |
is amended by changing Section 6.11 as follows:
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(5 ILCS 375/6.11)
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Sec. 6.11. Required health benefits; Illinois Insurance |
Code
requirements. The program of health
benefits shall |
provide the post-mastectomy care benefits required to be |
covered
by a policy of accident and health insurance under |
Section 356t of the Illinois
Insurance Code. The program of |
health benefits shall provide the coverage
required under |
Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, |
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, |
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, |
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, |
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, |
and 356z.53 and 356z.43 of the
Illinois Insurance Code.
The |
program of health benefits must comply with Sections 155.22a, |
155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of |
the
Illinois Insurance Code. The Department of Insurance shall |
enforce the requirements of this Section with respect to |
Sections 370c and 370c.1 of the Illinois Insurance Code; all |
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other requirements of this Section shall be enforced by the |
Department of Central Management Services.
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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. 101-13, eff. 6-12-19; 101-281, 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; 102-30, eff. 1-1-22; 102-103, |
eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; |
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised |
10-26-21.)
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Section 10. The Counties Code is amended by changing |
Section 5-1069.3 as follows:
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(55 ILCS 5/5-1069.3)
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Sec. 5-1069.3. Required health benefits. If a county, |
including a home
rule
county, is a self-insurer for purposes |
of providing health insurance coverage
for its employees, the |
coverage shall include coverage for 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, 356g.5, 356g.5-1, 356q, 356u,
356w, 356x, |
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356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, |
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, |
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, and 356z.53 and |
356z.43 of
the Illinois Insurance Code. The coverage shall |
comply with Sections 155.22a, 355b, 356z.19, and 370c of
the |
Illinois Insurance Code. The Department of Insurance shall |
enforce the requirements of this Section. The requirement that |
health benefits be covered
as provided in this Section is an
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exclusive power and function of the State and is a denial and |
limitation under
Article VII, Section 6, subsection (h) of the |
Illinois Constitution. A home
rule county to which this |
Section applies must comply with every provision of
this |
Section.
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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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; |
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, |
eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; |
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised |
10-26-21.)
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Section 15. The Illinois Municipal Code is amended by |
changing Section 10-4-2.3 as follows:
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(65 ILCS 5/10-4-2.3)
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Sec. 10-4-2.3. Required health benefits. If a |
municipality, including a
home rule municipality, is a |
self-insurer for purposes of providing health
insurance |
coverage for its employees, the coverage shall include |
coverage for
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, |
356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.6, 356z.8, |
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, |
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, |
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, |
356z.48, 356z.51, and 356z.53 and 356z.43 of the Illinois
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Insurance
Code. The coverage shall comply with Sections |
155.22a, 355b, 356z.19, and 370c of
the Illinois Insurance |
Code. The Department of Insurance shall enforce the |
requirements of this Section. The requirement that health
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benefits be covered as provided in this is an exclusive power |
and function of
the State and is a denial and limitation under |
Article VII, Section 6,
subsection (h) of the Illinois |
Constitution. A home rule municipality to which
this Section |
applies must comply with every provision of this Section.
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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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; |
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, |
eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; |
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised |
10-26-21.)
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Section 20. The School Code is amended by changing Section |
10-22.3f as follows:
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(105 ILCS 5/10-22.3f)
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Sec. 10-22.3f. Required health benefits. Insurance |
protection and
benefits
for employees shall 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, 356g.5, 356g.5-1, |
356q, 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, |
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, |
356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, |
356z.41, 356z.45, 356z.46, 356z.47, 356z.51, and 356z.53 and |
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356z.43 of
the
Illinois Insurance Code.
Insurance policies |
shall comply with Section 356z.19 of the Illinois Insurance |
Code. The coverage shall comply with Sections 155.22a, 355b, |
and 370c of
the Illinois Insurance Code. The Department of |
Insurance shall enforce the requirements of this Section.
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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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; |
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, |
eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; |
102-665, eff. 10-8-21; revised 10-27-21.)
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Section 25. The Illinois Insurance Code is amended by |
adding Section 356z.53 as follows:
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(215 ILCS 5/356z.53 new) |
Sec. 356z.53. Coverage for 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 on or after January 1, 2024 shall provide |
coverage for medically necessary hormone therapy treatment to |
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treat menopause that has been induced by a hysterectomy.
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Section 30. The Health Maintenance Organization Act is |
amended by changing Section 5-3 as follows:
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(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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Sec. 5-3. Insurance Code provisions.
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(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, 356q, 356v, 356w, 356x, 356y,
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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.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50, |
356z.51, 356z.53, 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,
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XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the |
Illinois Insurance Code.
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(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 |
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are deemed to be "domestic companies":
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(1) a corporation authorized under the
Dental Service |
Plan Act or the Voluntary Health Services Plans Act;
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(2) a corporation organized under the laws of this |
State; or
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(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
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organization as is a "domestic company" under Article VIII |
1/2 of the
Illinois Insurance Code.
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(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,
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(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
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acquisition of control takes effect;
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(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
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acquisition of control, need not take into account the |
effect on
competition of the merger, consolidation, or |
other acquisition of control;
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(3) the Director shall have the power to require the |
following
information:
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(A) certification by an independent actuary of the |
adequacy
of the reserves of the Health Maintenance |
Organization sought to be acquired;
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(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;
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(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
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(D) such other information as the Director shall |
require.
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(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
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enrollee population (including without limitation the health |
maintenance
organization's right, title, and interest in and |
to its health care
certificates).
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(e) In considering any management contract or service |
agreement subject
to Section 141.1 of the Illinois Insurance |
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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
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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.
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(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
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group or other enrollment unit to effect refunds or charge |
additional premiums
under the following terms and conditions:
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(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
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additional premium is to be charged (which period shall |
not be less than one
year); and
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(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 |
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premium, the profitable or unprofitable
experience shall |
be calculated taking into account a pro rata share of the
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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.
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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
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experience with respect to the group or enrollment unit and |
the resulting
additional premium to be paid by the group or |
enrollment unit.
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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.
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(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. 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; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
eff. 10-8-21; revised 10-27-21.)
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Section 35. The Voluntary Health Services Plans Act is |
amended by changing Section 10 as follows:
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(215 ILCS 165/10) (from Ch. 32, par. 604)
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Sec. 10. Application of Insurance Code provisions. Health |
services
plan corporations and all persons interested therein |
or dealing therewith
shall be subject to the provisions of |
Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, |
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, |
356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, |
356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, |
356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, |
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356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, |
356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40, |
356z.41, 356z.46, 356z.47, 356z.51, 356z.53 356z.43, 364.01, |
367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, |
and paragraphs (7) and (15) of Section 367 of the Illinois
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Insurance Code.
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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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; |
101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. |
1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, |
eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; |
revised 10-27-21.)
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Section 40. The Illinois Public Aid Code is amended by |
changing Section 5-16.8 as follows:
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(305 ILCS 5/5-16.8)
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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
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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, and 356z.53 and 356z.43 of the Illinois
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Insurance Code, (ii) be subject to the provisions of Sections |
356z.19, 356z.43, 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.
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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. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; |
101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. |
1-1-20; 101-649, eff. 7-7-20; 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; revised 10-27-21.)
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