Bill Text: IL HB3960 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the medical assistance program shall be subject to provisions of the Illinois Insurance Code concerning telehealth services. Makes a conforming change in the Illinois Insurance Code.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2023-03-10 - Rule 19(a) / Re-referred to Rules Committee [HB3960 Detail]

Download: Illinois-2023-HB3960-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3960 Introduced , by Rep. Lindsey LaPointe SYNOPSIS AS INTRODUCED:
215 ILCS 5/352 from Ch. 73, par. 964
305 ILCS 5/5-16.8
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the medical assistance program shall be subject to provisions of the Illinois Insurance Code concerning telehealth services. Makes a conforming change in the Illinois Insurance Code.
LRB103 31065 BMS 57688 b
A BILL FOR
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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 352 as follows:
(215 ILCS 5/352) (from Ch. 73, par. 964)
Sec. 352. Scope of Article.
(a) Except as provided in subsections (b), (c), (d), and
(e), this Article shall apply to all companies transacting in
this State the kinds of business enumerated in clause (b) of
Class 1 and clause (a) of Class 2 of Section 4. Nothing in this
Article shall apply to, or in any way affect policies or
contracts described in clause (a) of Class 1 of Section 4;
however, this Article shall apply to policies and contracts
which contain benefits providing reimbursement for the
expenses of long term health care which are certified or
ordered by a physician including but not limited to
professional nursing care, custodial nursing care, and
non-nursing custodial care provided in a nursing home or at a
residence of the insured.
(b) (Blank).
(c) A policy issued and delivered in this State that
provides coverage under that policy for certificate holders

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who are neither residents of nor employed in this State does
not need to provide to those nonresident certificate holders
who are not employed in this State the coverages or services
mandated by this Article.
(d) Stop-loss insurance is exempt from all Sections of
this Article, except this Section and Sections 353a, 354,
357.30, and 370. For purposes of this exemption, stop-loss
insurance is further defined as follows:
(1) The policy must be issued to and insure an
employer, trustee, or other sponsor of the plan, or the
plan itself, but not employees, members, or participants.
(2) Payments by the insurer must be made to the
employer, trustee, or other sponsors of the plan, or the
plan itself, but not to the employees, members,
participants, or health care providers.
(e) A policy issued or delivered in this State to the
Department of Healthcare and Family Services (formerly
Illinois Department of Public Aid) and providing coverage,
under clause (b) of Class 1 or clause (a) of Class 2 as
described in Section 4, to persons who are enrolled under
Article V of the Illinois Public Aid Code or under the
Children's Health Insurance Program Act is exempt from all
restrictions, limitations, standards, rules, or regulations
respecting benefits imposed by or under authority of this
Code, except those specified by subsection (1) of Section 143,
Section 356z.22, Section 370c, and Section 370c.1. Nothing in

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this subsection, however, affects the total medical services
available to persons eligible for medical assistance under the
Illinois Public Aid Code.
(f) An in-office membership care agreement provided under
the In-Office Membership Care Act is not insurance for the
purposes of this Code.
(Source: P.A. 101-190, eff. 8-2-19.)
Section 10. The Illinois Public Aid Code is amended by
changing Section 5-16.8 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, and 356z.60 of
the Illinois Insurance Code, (ii) be subject to the provisions
of Sections 356z.19, 356z.22, 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

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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; 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.)