Illinois-2023-SB2759-Introduced

103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2759

Introduced 1/16/2024, by Sen. Mattie Hunter

SYNOPSIS AS INTRODUCED:

See Index

Creates the Adoptee Baseline Medical Testing Act. Requires medical intake forms for services provided by health care providers to include questions concerning the patient's adoption status and, if adopted, whether the patient has access to the patient's biological medical history. Provides that, if a patient has indicated on the medical intake form that the patient is adopted and does not have access to the patient's biological medical history, then, upon request by the patient or patient's parent or guardian, the health care provider shall provide no-cost, baseline testing with minimized time-bound restrictions for genetically predisposed conditions or diseases. Provides that if the patient or patient's parent or guardian requests such testing and the health care provider does not have personnel qualified to perform the testing, the health care provider must make a referral to another health care provider that is qualified to perform the testing and that will accept the referral. Subject to appropriation, requires the Department of Public Health, by rule, to create a State-funded system to pay for the baseline testing to the extent that another source does not cover the cost of the testing. Requires the Department of Public Health to develop educational materials and presentations for distribution to health care providers that provide information on the need for access to biological medical history and the detriments of lack of access to biological medical history for adoptees. Provides that the Department of Public Health shall administer and enforce the Act. Amends the Illinois Insurance Code to require coverage for baseline testing for genetically predisposed conditions or diseases if a patient has indicated on a medical intake form that the patient is adopted and does not have access to the patient's biological medical history. Provides that such a policy shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code.

LRB103 36075 CES 66164 b

A BILL FOR

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1 AN ACT concerning health.

2 Be it enacted by the People of the State of Illinois,

3 represented in the General Assembly:

4 Section 1. Short title. This Act may be cited as the

5 Adoptee Baseline Medical Testing Act.

6 Section 5. Definitions. As used in this Act:

7 "Health care provider" means any public or private

8 facility that provides, on an inpatient or outpatient basis,

9 preventive, diagnostic, therapeutic, convalescent,

10 rehabilitation, mental health, or intellectual disability

11 services, including general or special hospitals, skilled

12 nursing homes, extended care facilities, intermediate care

13 facilities and mental health centers.

14 "Patient" means any person who has received or is

15 receiving medical care, treatment or services from an

16 individual or institution licensed to provide medical care or

17 treatment in this State.

18 Section 10. Medical intake forms; baseline testing.

19 Medical intake forms for services provided by health care

20 providers must include questions concerning:

21 (1) the patient's adoption status; and

22 (2) if adopted, whether the patient has access to the

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1 patient's biological medical history.

2 If a patient has indicated on the medical intake form that

3 the patient is adopted and does not have access to the

4 patient's biological medical history, then, upon request by

5 the patient or patient's parent or guardian, the health care

6 provider, shall provide no-cost, baseline testing with

7 minimized time-bound restrictions for genetically predisposed

8 conditions or diseases, including, but not limited to,

9 hypertension, diabetes, conditions or diseases related to

10 reproductive health, and cancers. If the patient or patient's

11 parent or guardian requests such testing and the health care

12 provider does not have personnel qualified to perform the

13 testing, the health care provider must make a referral to

14 another health care provider that is qualified to perform the

15 testing and that will accept the referral.

16 This Act shall not be construed to require baseline

17 testing more than once.

18 Section 15. Payment. Subject to appropriation, the

19 Department of Public Health shall, by rule, create a

20 State-funded system to pay for baseline testing under Section

21 10 to the extent that another source does not cover the cost of

22 the testing. The patient must apply to any source that may be

23 required to pay for testing, and may apply to the Department of

24 Public Health only if all such applications are rejected. The

25 patient must supply documentation of rejections, including

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1 appeals, to the Department of Public Health in accordance with

2 the Department's rules.

3 Section 20. Educational materials. The Department of

4 Public Health shall develop educational materials and

5 presentations for distribution to health care providers that

6 provide information on the need for access to biological

7 medical history and the detriments of lack of access to

8 biological medical history for adoptees.

9 Section 25. Enforcement. The Department of Public Health

10 shall administer and enforce this Act.

11 Section 900. The State Employees Group Insurance Act of

12 1971 is amended by changing Section 6.11 as follows:

13 (5 ILCS 375/6.11)

14 Sec. 6.11. Required health benefits; Illinois Insurance

15 Code requirements. The program of health benefits shall

16 provide the post-mastectomy care benefits required to be

17 covered by a policy of accident and health insurance under

18 Section 356t of the Illinois Insurance Code. The program of

19 health benefits shall provide the coverage required under

20 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,

21 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,

22 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,

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1 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

2 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,

3 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,

4 ~~and~~ 356z.61, ~~and~~ 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,

5 and 356z.71 of the Illinois Insurance Code. The program of

6 health benefits must comply with Sections 155.22a, 155.37,

7 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the

8 Illinois Insurance Code. The program of health benefits shall

9 provide the coverage required under Section 356m of the

10 Illinois Insurance Code and, for the employees of the State

11 Employee Group Insurance Program only, the coverage as also

12 provided in Section 6.11B of this Act. The Department of

13 Insurance shall enforce the requirements of this Section with

14 respect to Sections 370c and 370c.1 of the Illinois Insurance

15 Code; all other requirements of this Section shall be enforced

16 by the Department of Central Management Services.

17 Rulemaking authority to implement Public Act 95-1045, if

18 any, is conditioned on the rules being adopted in accordance

19 with all provisions of the Illinois Administrative Procedure

20 Act and all rules and procedures of the Joint Committee on

21 Administrative Rules; any purported rule not so adopted, for

22 whatever reason, is unauthorized.

23 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;

24 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.

25 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,

26 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

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1 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.

2 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,

3 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;

4 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.

5 8-11-23; revised 8-29-23.)

6 Section 905. The Counties Code is amended by changing

7 Section 5-1069.3 as follows:

8 (55 ILCS 5/5-1069.3)

9 Sec. 5-1069.3. Required health benefits. If a county,

10 including a home rule county, is a self-insurer for purposes

11 of providing health insurance coverage for its employees, the

12 coverage shall include coverage for the post-mastectomy care

13 benefits required to be covered by a policy of accident and

14 health insurance under Section 356t and the coverage required

15 under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,

16 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,

17 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,

18 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,

19 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,

20 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, ~~and~~ 356z.61, ~~and~~

21 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of

22 the Illinois Insurance Code. The coverage shall comply with

23 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois

24 Insurance Code. The Department of Insurance shall enforce the

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1 requirements of this Section. The requirement that health

2 benefits be covered as provided in this Section is an

3 exclusive power and function of the State and is a denial and

4 limitation under Article VII, Section 6, subsection (h) of the

5 Illinois Constitution. A home rule county to which this

6 Section applies must comply with every provision of this

7 Section.

8 Rulemaking authority to implement Public Act 95-1045, if

9 any, is conditioned on the rules being adopted in accordance

10 with all provisions of the Illinois Administrative Procedure

11 Act and all rules and procedures of the Joint Committee on

12 Administrative Rules; any purported rule not so adopted, for

13 whatever reason, is unauthorized.

14 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;

15 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.

16 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,

17 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

18 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.

19 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,

20 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;

21 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised

22 8-29-23.)

23 Section 910. The Illinois Municipal Code is amended by

24 changing Section 10-4-2.3 as follows:

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1 (65 ILCS 5/10-4-2.3)

2 Sec. 10-4-2.3. Required health benefits. If a

3 municipality, including a home rule municipality, is a

4 self-insurer for purposes of providing health insurance

5 coverage for its employees, the coverage shall include

6 coverage for the post-mastectomy care benefits required to be

7 covered by a policy of accident and health insurance under

8 Section 356t and the coverage required under Sections 356g,

9 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,

10 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

11 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,

12 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,

13 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,

14 356z.56, 356z.57, 356z.59, 356z.60, ~~and~~ 356z.61, ~~and~~ 356z.62,

15 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the

16 Illinois Insurance Code. The coverage shall comply with

17 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois

18 Insurance Code. The Department of Insurance shall enforce the

19 requirements of this Section. The requirement that health

20 benefits be covered as provided in this is an exclusive power

21 and function of the State and is a denial and limitation under

22 Article VII, Section 6, subsection (h) of the Illinois

23 Constitution. A home rule municipality to which this Section

24 applies must comply with every provision of this Section.

25 Rulemaking authority to implement Public Act 95-1045, if

26 any, is conditioned on the rules being adopted in accordance

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1 with all provisions of the Illinois Administrative Procedure

2 Act and all rules and procedures of the Joint Committee on

3 Administrative Rules; any purported rule not so adopted, for

4 whatever reason, is unauthorized.

5 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;

6 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.

7 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,

8 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;

9 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.

10 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,

11 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;

12 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised

13 8-29-23.)

14 Section 915. The School Code is amended by changing

15 Section 10-22.3f as follows:

16 (105 ILCS 5/10-22.3f)

17 Sec. 10-22.3f. Required health benefits. Insurance

18 protection and benefits for employees shall provide the

19 post-mastectomy care benefits required to be covered by a

20 policy of accident and health insurance under Section 356t and

21 the coverage required under Sections 356g, 356g.5, 356g.5-1,

22 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,

23 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,

24 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

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1 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,

2 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, ~~and~~

3 356z.61, ~~and~~ 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and

4 356z.71 of the Illinois Insurance Code. Insurance policies

5 shall comply with Section 356z.19 of the Illinois Insurance

6 Code. The coverage shall comply with Sections 155.22a, 355b,

7 and 370c of the Illinois Insurance Code. The Department of

8 Insurance shall enforce the requirements of this Section.

9 Rulemaking authority to implement Public Act 95-1045, if

10 any, is conditioned on the rules being adopted in accordance

11 with all provisions of the Illinois Administrative Procedure

12 Act and all rules and procedures of the Joint Committee on

13 Administrative Rules; any purported rule not so adopted, for

14 whatever reason, is unauthorized.

15 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;

16 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.

17 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,

18 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;

19 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.

20 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,

21 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;

22 103-551, eff. 8-11-23; revised 8-29-23.)

23 Section 920. The Illinois Insurance Code is amended by

24 adding Section 356z.71 as follows:

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1 (215 ILCS 5/356z.71 new)

2 Sec. 356z.71. Adoptee baseline medical testing. An

3 individual or group policy of accident and health insurance

4 amended, delivered, issued, or renewed in this State on or

5 after January 1, 2025 shall provide coverage for baseline

6 testing for genetically predisposed conditions or diseases,

7 including, but not limited to, hypertension, diabetes,

8 conditions or diseases related to reproductive health, and

9 cancers, if a patient has indicated on a medical intake form

10 that the patient is adopted and does not have access to the

11 patient's biological medical history. A policy subject to this

12 Section shall not impose a deductible, coinsurance, copayment,

13 or any other cost-sharing requirement on the coverage

14 provided.

15 Section 925. The Health Maintenance Organization Act is

16 amended by changing Section 5-3 as follows:

17 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)

18 Sec. 5-3. Insurance Code provisions.

19 (a) Health Maintenance Organizations shall be subject to

20 the provisions of Sections 133, 134, 136, 137, 139, 140,

21 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,

22 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,

23 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,

24 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,

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1 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,

2 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,

3 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,

4 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,

5 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,

6 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,

7 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,

8 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,

9 356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,

10 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,

11 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of

12 subsection (2) of Section 367, and Articles IIA, VIII 1/2,

13 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the

14 Illinois Insurance Code.

15 (b) For purposes of the Illinois Insurance Code, except

16 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,

17 Health Maintenance Organizations in the following categories

18 are deemed to be "domestic companies":

19 (1) a corporation authorized under the Dental Service

20 Plan Act or the Voluntary Health Services Plans Act;

21 (2) a corporation organized under the laws of this

22 State; or

23 (3) a corporation organized under the laws of another

24 state, 30% or more of the enrollees of which are residents

25 of this State, except a corporation subject to

26 substantially the same requirements in its state of

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1 organization as is a "domestic company" under Article VIII

2 1/2 of the Illinois Insurance Code.

3 (c) In considering the merger, consolidation, or other

4 acquisition of control of a Health Maintenance Organization

5 pursuant to Article VIII 1/2 of the Illinois Insurance Code,

6 (1) the Director shall give primary consideration to

7 the continuation of benefits to enrollees and the

8 financial conditions of the acquired Health Maintenance

9 Organization after the merger, consolidation, or other

10 acquisition of control takes effect;

11 (2)(i) the criteria specified in subsection (1)(b) of

12 Section 131.8 of the Illinois Insurance Code shall not

13 apply and (ii) the Director, in making his determination

14 with respect to the merger, consolidation, or other

15 acquisition of control, need not take into account the

16 effect on competition of the merger, consolidation, or

17 other acquisition of control;

18 (3) the Director shall have the power to require the

19 following information:

20 (A) certification by an independent actuary of the

21 adequacy of the reserves of the Health Maintenance

22 Organization sought to be acquired;

23 (B) pro forma financial statements reflecting the

24 combined balance sheets of the acquiring company and

25 the Health Maintenance Organization sought to be

26 acquired as of the end of the preceding year and as of

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1 a date 90 days prior to the acquisition, as well as pro

2 forma financial statements reflecting projected

3 combined operation for a period of 2 years;

4 (C) a pro forma business plan detailing an

5 acquiring party's plans with respect to the operation

6 of the Health Maintenance Organization sought to be

7 acquired for a period of not less than 3 years; and

8 (D) such other information as the Director shall

9 require.

10 (d) The provisions of Article VIII 1/2 of the Illinois

11 Insurance Code and this Section 5-3 shall apply to the sale by

12 any health maintenance organization of greater than 10% of its

13 enrollee population (including, without limitation, the health

14 maintenance organization's right, title, and interest in and

15 to its health care certificates).

16 (e) In considering any management contract or service

17 agreement subject to Section 141.1 of the Illinois Insurance

18 Code, the Director (i) shall, in addition to the criteria

19 specified in Section 141.2 of the Illinois Insurance Code,

20 take into account the effect of the management contract or

21 service agreement on the continuation of benefits to enrollees

22 and the financial condition of the health maintenance

23 organization to be managed or serviced, and (ii) need not take

24 into account the effect of the management contract or service

25 agreement on competition.

26 (f) Except for small employer groups as defined in the

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1 Small Employer Rating, Renewability and Portability Health

2 Insurance Act and except for medicare supplement policies as

3 defined in Section 363 of the Illinois Insurance Code, a

4 Health Maintenance Organization may by contract agree with a

5 group or other enrollment unit to effect refunds or charge

6 additional premiums under the following terms and conditions:

7 (i) the amount of, and other terms and conditions with

8 respect to, the refund or additional premium are set forth

9 in the group or enrollment unit contract agreed in advance

10 of the period for which a refund is to be paid or

11 additional premium is to be charged (which period shall

12 not be less than one year); and

13 (ii) the amount of the refund or additional premium

14 shall not exceed 20% of the Health Maintenance

15 Organization's profitable or unprofitable experience with

16 respect to the group or other enrollment unit for the

17 period (and, for purposes of a refund or additional

18 premium, the profitable or unprofitable experience shall

19 be calculated taking into account a pro rata share of the

20 Health Maintenance Organization's administrative and

21 marketing expenses, but shall not include any refund to be

22 made or additional premium to be paid pursuant to this

23 subsection (f)). The Health Maintenance Organization and

24 the group or enrollment unit may agree that the profitable

25 or unprofitable experience may be calculated taking into

26 account the refund period and the immediately preceding 2

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1 plan years.

2 The Health Maintenance Organization shall include a

3 statement in the evidence of coverage issued to each enrollee

4 describing the possibility of a refund or additional premium,

5 and upon request of any group or enrollment unit, provide to

6 the group or enrollment unit a description of the method used

7 to calculate (1) the Health Maintenance Organization's

8 profitable experience with respect to the group or enrollment

9 unit and the resulting refund to the group or enrollment unit

10 or (2) the Health Maintenance Organization's unprofitable

11 experience with respect to the group or enrollment unit and

12 the resulting additional premium to be paid by the group or

13 enrollment unit.

14 In no event shall the Illinois Health Maintenance

15 Organization Guaranty Association be liable to pay any

16 contractual obligation of an insolvent organization to pay any

17 refund authorized under this Section.

18 (g) Rulemaking authority to implement Public Act 95-1045,

19 if any, is conditioned on the rules being adopted in

20 accordance with all provisions of the Illinois Administrative

21 Procedure Act and all rules and procedures of the Joint

22 Committee on Administrative Rules; any purported rule not so

23 adopted, for whatever reason, is unauthorized.

24 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;

25 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.

26 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,

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1 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;

2 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.

3 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,

4 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;

5 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.

6 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,

7 eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)

8 Section 930. The Limited Health Service Organization Act

9 is amended by changing Section 4003 as follows:

10 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)

11 Sec. 4003. Illinois Insurance Code provisions. Limited

12 health service organizations shall be subject to the

13 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,

14 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,

15 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,

16 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,

17 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,

18 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,

19 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,

20 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,

21 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,

22 XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.

23 Nothing in this Section shall require a limited health care

24 plan to cover any service that is not a limited health service.

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LRB103 36075 CES 66164 b

1 For purposes of the Illinois Insurance Code, except for

2 Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited

3 health service organizations in the following categories are

4 deemed to be domestic companies:

5 (1) a corporation under the laws of this State; or

6 (2) a corporation organized under the laws of another

7 state, 30% or more of the enrollees of which are residents

8 of this State, except a corporation subject to

9 substantially the same requirements in its state of

10 organization as is a domestic company under Article VIII

11 1/2 of the Illinois Insurance Code.

12 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;

13 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.

14 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,

15 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;

16 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.

17 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,

18 eff. 1-1-24; revised 8-29-23.)

19 Section 935. The Voluntary Health Services Plans Act is

20 amended by changing Section 10 as follows:

21 (215 ILCS 165/10) (from Ch. 32, par. 604)

22 Sec. 10. Application of Insurance Code provisions. Health

23 services plan corporations and all persons interested therein

24 or dealing therewith shall be subject to the provisions of

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LRB103 36075 CES 66164 b

1 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,

2 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,

3 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,

4 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,

5 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

6 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,

7 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,

8 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,

9 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,

10 356z.67, 356z.68, 356z.71, 364.01, 364.3, 367.2, 368a, 401,

11 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)

12 and (15) of Section 367 of the Illinois Insurance Code.

13 Rulemaking authority to implement Public Act 95-1045, if

14 any, is conditioned on the rules being adopted in accordance

15 with all provisions of the Illinois Administrative Procedure

16 Act and all rules and procedures of the Joint Committee on

17 Administrative Rules; any purported rule not so adopted, for

18 whatever reason, is unauthorized.

19 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;

20 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.

21 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,

22 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;

23 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.

24 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,

25 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;

26 103-551, eff. 8-11-23; revised 8-29-23.)

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LRB103 36075 CES 66164 b

1 Section 940. The Illinois Public Aid Code is amended by

2 changing Section 5-16.8 as follows:

3 (305 ILCS 5/5-16.8)

4 Sec. 5-16.8. Required health benefits. The medical

5 assistance program shall (i) provide the post-mastectomy care

6 benefits required to be covered by a policy of accident and

7 health insurance under Section 356t and the coverage required

8 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,

9 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,

10 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, ~~and~~

11 356z.61, 356z.64, 356z.67, and 356z.71 of the Illinois

12 Insurance Code, (ii) be subject to the provisions of Sections

13 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the

14 Illinois Insurance Code, and (iii) be subject to the

15 provisions of subsection (d-5) of Section 10 of the Network

16 Adequacy and Transparency Act.

17 The Department, by rule, shall adopt a model similar to

18 the requirements of Section 356z.39 of the Illinois Insurance

19 Code.

20 On and after July 1, 2012, the Department shall reduce any

21 rate of reimbursement for services or other payments or alter

22 any methodologies authorized by this Code to reduce any rate

23 of reimbursement for services or other payments in accordance

24 with Section 5-5e.

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LRB103 36075 CES 66164 b

1 To ensure full access to the benefits set forth in this

2 Section, on and after January 1, 2016, the Department shall

3 ensure that provider and hospital reimbursement for

4 post-mastectomy care benefits required under this Section are

5 no lower than the Medicare reimbursement rate.

6 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;

7 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.

8 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,

9 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;

10 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.

11 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)

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LRB103 36075 CES 66164 b

INDEX

Statutes amended in order of appearance