HB 1918 — JOINT SELF-INSURANCE

*LRB10406023BAB16056b* HB1918 104THEngrossed GENERALLRB104 ASSEMBLY06023 StateBAB of16056 Illinoisb andAN 2026ACT HB1918concerning Introducedregulation. 1/29/2025, by Rep.

Anthony DeLuca SYNOPSIS AS INTRODUCED:

ILCS 134/10 Amends the Managed Care Reform and Patient Rights Act.

Provides that any intergovernmental joint self-insurance pool providing health benefits under a specified provision of the Intergovernmental Cooperation Act shall not be included under the definition of "health care plan".

Effective immediately.

LRB104 06023 BAB 16056 b A BILL FOR HB1918 LRB104 06023 BAB 16056 b AN ACT concerning regulation.

(1) placing the health of the individual (or, with HB1918 Engrossed - 2 - LRB104 06023 BAB 16056 b respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;

HB1918 Engrossed - 3 - LRB104 06023 BAB 16056 b "Enrollee" means any person and his or her dependents enrolled in or covered by a health care plan.

"Health care plan" means a plan, including, but not limited to, a health maintenance organization, a managed care community network as defined in the Illinois Public Aid Code, or an accountable care entity as defined in the Illinois Public Aid Code that receives capitated payments to cover medical services from the Department of Healthcare and Family Services, that establishes, operates, or maintains a network of health care providers that has entered into an agreement with the plan to provide health care services to enrollees to whom the plan has the ultimate obligation to arrange for the provision of or payment for services through organizational HB1918 Engrossed - 4 - LRB104 06023 BAB 16056 b arrangements for ongoing quality assurance, utilization review programs, or dispute resolution.

and (6) except with respect to subsections (a) and (b) of Section 65 and subsection (a-5) of Section 70, not-for-profit voluntary health services plans with health maintenance organization authority in existence as of January 1, 1999 that are affiliated with a union and that only extend coverage to union members and their HB1918 Engrossed - 5 - LRB104 06023 BAB 16056 b dependents;

HB1918 Engrossed - 6 - LRB104 06023 BAB 16056 b "Medically necessary" means that a service or product addresses the specific needs of a patient for the purpose of screening, preventing, diagnosing, managing, or treating an illness, injury, or condition or its symptoms and comorbidities, including minimizing the progression of an illness, injury, or condition or its symptoms and comorbidities, in a manner that is all of the following:

HB1918 Engrossed - 7 - LRB104 06023 BAB 16056 b "Stabilization" means, with respect to an emergency medical condition, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result.

or HB1918 Engrossed - 8 - LRB104 06023 BAB 16056 b (5) for health care plans operated or overseen by the Department of Healthcare and Family Services, including Medicaid managed care plans, any utilization controls mandated by 42 CFR 456.703 or a preferred drug list as described in Section 5-30.14 of the Illinois Public Aid Code.

"Utilization review criteria" means criteria, standards, HB1918 Engrossed - 9 - LRB104 06023 BAB 16056 b protocols, or guidelines used by a utilization review program to conduct utilization review to ensure that a patient's care is aligned with generally accepted standards of care and consistent with State law.