Illinois 95th Regular Session Status: Passed House 4 D cosponsors

HB 5192 — BREAST CANCER SCREEN,TREATMENT

Last action — Session Sine Die

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed House
  4. 4
    Passed Senate
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 95th Regular Session. It reached “Passed House” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Amends the Illinois Public Aid Code, the Illinois Insurance Code, and other Acts. Provides that on and after July 1, 2008, screening and diagnostic mammography shall be reimbursed under the medical assistance program at the same rate as the Medicare program's rates, including the increased reimbursement for digital mammography. Requires the Department of Healthcare and Family Services to take certain actions in relation to breast cancer screening and treatment, including establishment of bonus payments to mammography facilities meeting certain standards, a rate methodology for certain providers, and a performance goal for primary care providers; also requires the Department to establish a case-management or patient-navigation pilot program. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act must provide coverage for all medically necessary pain medication and pain therapy related to the treatment of breast cancer on the same terms and conditions that are generally applicable to coverage for other conditions. Provides that mandatory insurance coverage relating to mammography shall be provided at no cost to the insured and shall not be subject to an annual or lifetime maximum benefit. Makes other changes in relation to mammography coverage, and makes these changes to the Illinois Insurance Code also applicable to the State Employees Group Insurance Act of 1971, the Health Maintenance Organization Act, and other Acts. Sets forth a statement of legislative intent and provides that the bill's provisions may be referred to as the Reducing Breast Cancer Disparities Act. Effective immediately.

Bill Text

What changed in the latest version

1420 added · 1225 removed

Plain-language change summary

The updated version of Bill HB 5192 adds specific guidelines for mammogram coverage for women, establishing that those ages 35 to 39 should receive baseline mammograms, while annual mammograms are required for those 40 and older. It also includes enhanced support for women undergoing breast cancer treatment, such as coverage for pain medication and therapy. These changes are important because they aim to improve access to necessary screenings and treatments, ultimately leading to better health outcomes for women facing breast cancer.

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*LRB09517610DRJ45972b* HB5192 95TH GENERAL ASSEMBLY State of Illinois and 2008 HB5192 by Rep.
HB5192 Engrossed LRB095 17610 DRJ 45972 b AN ACT concerning health, which may be referred to as the Reducing Breast Cancer Disparities Act.
Greg Harris SYNOPSIS AS INTRODUCED:
See Index Amends the Illinois Public Aid Code, the Illinois Insurance Code, and other Acts.
Provides that on and after July 1, 2008, screening and diagnostic mammography shall be reimbursed under the medical assistance program at the same rate as the Medicare program’s rates, including the increased reimbursement for digital mammography.
Requires the Department of Healthcare and Family Services to take certain actions in relation to breast cancer screening and treatment, including establishment of bonus payments to mammography facilities meeting certain standards, a rate methodology for certain providers, and a performance goal for primary care providers;
also requires the Department to establish a case-management or patient-navigation pilot program.
Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act must provide coverage for all medically necessary pain medication and pain therapy related to the treatment of breast cancer on the same terms and conditions that are generally applicable to coverage for other conditions.
Provides that mandatory insurance coverage relating to mammography shall be provided at no cost to the insured and shall not be subject to an annual or lifetime maximum benefit.
Makes other changes in relation to mammography coverage, and makes these changes to the Illinois Insurance Code also applicable to the State Employees Group Insurance Act of 1971, the Health Maintenance Organization Act, and other Acts.
Sets forth a statement of legislative intent and provides that the bill’s provisions may be referred to as the Reducing Breast Cancer Disparities Act.
Effective immediately.
LRB095 17610 DRJ 45972 b FISCAL NOTE ACT STATE MANDATES MAY APPLY ACT MAY REQUIRE REIMBURSEMENT A BILL FOR HB5192 LRB095 17610 DRJ 45972 b AN ACT concerning health, which may be referred to as the Reducing Breast Cancer Disparities Act.
Improving State Healthcare Programs With Respect To Mammography And Breast Cancer Treatment HB5192 - 2 - LRB095 17610 DRJ 45972 b Section 5-5.
Improving State Healthcare Programs With Respect To Mammography And Breast Cancer Treatment HB5192 Engrossed - 2 - LRB095 17610 DRJ 45972 b Section 5-5.
(15) medical treatment of sexual HB5192 - 3 - LRB095 17610 DRJ 45972 b assault survivors, as defined in Section 1a of the Sexual Assault Survivors Emergency Treatment Act, for injuries sustained as a result of the sexual assault, including examinations and laboratory tests to discover evidence which may be used in criminal proceedings arising from the sexual assault;
(15) medical treatment of sexual HB5192 Engrossed - 3 - LRB095 17610 DRJ 45972 b assault survivors, as defined in Section 1a of the Sexual Assault Survivors Emergency Treatment Act, for injuries sustained as a result of the sexual assault, including examinations and laboratory tests to discover evidence which may be used in criminal proceedings arising from the sexual assault;
Notwithstanding any other provision of this Section, a comprehensive tobacco use cessation program that includes purchasing prescription drugs or prescription medical devices HB5192 - 4 - LRB095 17610 DRJ 45972 b approved by the Food and Drug administration shall be covered under the medical assistance program under this Article for persons who are otherwise eligible for assistance under this Article.
Notwithstanding any other provision of this Section, a comprehensive tobacco use cessation program that includes purchasing prescription drugs or prescription medical devices HB5192 Engrossed - 4 - LRB095 17610 DRJ 45972 b approved by the Food and Drug administration shall be covered under the medical assistance program under this Article for persons who are otherwise eligible for assistance under this Article.
The Department of Healthcare and Family Services must HB5192 - 5 - LRB095 17610 DRJ 45972 b provide coverage and reimbursement for amino acid-based elemental formulas, regardless of delivery method, for the diagnosis and treatment of (i) eosinophilic disorders and (ii) short bowel syndrome when the prescribing physician has issued a written order stating that the amino acid-based elemental formula is medically necessary.
The Department of Healthcare and Family Services must HB5192 Engrossed - 5 - LRB095 17610 DRJ 45972 b provide coverage and reimbursement for amino acid-based elemental formulas, regardless of delivery method, for the diagnosis and treatment of (i) eosinophilic disorders and (ii) short bowel syndrome when the prescribing physician has issued a written order stating that the amino acid-based elemental formula is medically necessary.
a baseline mammogram for women 35 to 39 years of age and an annual mammogram for women 40 years of age or older.
(A) A a baseline mammogram for women 35 to 39 years of age.
All screenings shall include a physical breast exam, instruction on self-examination and information regarding the frequency of self-examination and its value as a preventative tool.
and an (B) An annual mammogram for women 40 years of age or older.
For purposes of As used in this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, image receptors receptor, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with 2 views for each breast.
(C) A mammogram at the age and intervals considered medically necessary by the woman’s health care provider for women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, positive genetic testing, or other risk factors.
(D) A comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue, when medically necessary as determined by a physician licensed to practice medicine in all of its branches.
All screenings shall include a physical breast exam, HB5192 Engrossed - 6 - LRB095 17610 DRJ 45972 b instruction on self-examination and information regarding the frequency of self-examination and its value as a preventative tool.
For purposes of As used in this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and image receptor, and cassettes, with an average radiation exposure delivery of less than one rad per breast for mid-breast, with 2 views of an average size for each breast.
On and after July 1, 2008, screening and diagnostic mammography shall be reimbursed at the same rate as the Medicare program’s rates, including the increased HB5192 - 6 - LRB095 17610 DRJ 45972 b reimbursement for digital mammography.
On and after July 1, 2008, screening and diagnostic mammography shall be reimbursed at the same rate as the Medicare program’s rates, including the increased reimbursement for digital mammography.
These clinics or centers may also collaborate with other hospital-based mammography facilities.
These clinics or centers may also collaborate with other HB5192 Engrossed - 7 - LRB095 17610 DRJ 45972 b hospital-based mammography facilities.
The Department shall devise a means of case-managing or patient navigation for beneficiaries diagnosed with breast HB5192 - 7 - LRB095 17610 DRJ 45972 b cancer.
The Department shall devise a means of case-managing or patient navigation for beneficiaries diagnosed with breast cancer.
Any medical or health care provider shall immediately recommend, to any pregnant woman who is being provided prenatal services and is suspected of drug abuse or is addicted as defined in the Alcoholism and Other Drug Abuse and Dependency Act, referral to a local substance abuse treatment provider licensed by the Department of Human Services or to a licensed hospital which provides substance abuse treatment services.
Any medical or health care provider shall immediately recommend, to any pregnant woman who is being provided prenatal services and is suspected of drug abuse or is addicted as defined in the Alcoholism and Other Drug Abuse and Dependency HB5192 Engrossed - 8 - LRB095 17610 DRJ 45972 b Act, referral to a local substance abuse treatment provider licensed by the Department of Human Services or to a licensed hospital which provides substance abuse treatment services.
All medical providers providing medical assistance to pregnant women under this Code shall receive information from the Department on the availability of services under the Drug Free Families with a Future or any comparable program providing case management services for addicted women, including HB5192 - 8 - LRB095 17610 DRJ 45972 b information on appropriate referrals for other social services that may be needed by addicted women in addition to treatment for addiction.
All medical providers providing medical assistance to pregnant women under this Code shall receive information from the Department on the availability of services under the Drug Free Families with a Future or any comparable program providing case management services for addicted women, including information on appropriate referrals for other social services that may be needed by addicted women in addition to treatment for addiction.
Neither the Department of Healthcare and Family Services nor the Department of Human Services shall sanction the recipient solely on the basis of her substance abuse.
Neither the Department of Healthcare and Family Services nor the Department of Human Services shall sanction the HB5192 Engrossed - 9 - LRB095 17610 DRJ 45972 b recipient solely on the basis of her substance abuse.
HB5192 - 9 - LRB095 17610 DRJ 45972 b Implementation of this Section may be by demonstration projects in certain geographic areas.
Implementation of this Section may be by demonstration projects in certain geographic areas.
The Illinois Department shall reimburse medical services delivered by Partnership providers to clients in target areas according to provisions of this Article and the Illinois Health Finance Reform Act, except that:
The Illinois Department shall reimburse HB5192 Engrossed - 10 - LRB095 17610 DRJ 45972 b medical services delivered by Partnership providers to clients in target areas according to provisions of this Article and the Illinois Health Finance Reform Act, except that:
(3) Persons receiving medical services through Partnerships may receive medical and case management HB5192 - 10 - LRB095 17610 DRJ 45972 b services above the level usually offered through the medical assistance program.
(3) Persons receiving medical services through Partnerships may receive medical and case management services above the level usually offered through the medical assistance program.
Nothing in this Section shall limit the free choice of practitioners, hospitals, and other providers of medical services by clients.
Nothing in this Section shall limit the free choice of practitioners, hospitals, and other providers of medical HB5192 Engrossed - 11 - LRB095 17610 DRJ 45972 b services by clients.
The Illinois Department shall require health care providers to maintain records that document the medical care and services provided to recipients of Medical Assistance under HB5192 - 11 - LRB095 17610 DRJ 45972 b this Article.
The Illinois Department shall require health care providers to maintain records that document the medical care and services provided to recipients of Medical Assistance under this Article.
The rules and regulations shall require that proof of the receipt of prescription drugs, dentures, prosthetic devices and eyeglasses by eligible persons under this Section accompany each claim for reimbursement submitted by the dispenser of such medical services.
The rules and regulations shall require that proof of the receipt of prescription drugs, dentures, prosthetic devices and HB5192 Engrossed - 12 - LRB095 17610 DRJ 45972 b eyeglasses by eligible persons under this Section accompany each claim for reimbursement submitted by the dispenser of such medical services.
Within 90 days after the effective date of this amendatory Act of 1984, the Illinois Department shall establish a current list of acquisition costs for all prosthetic devices HB5192 - 12 - LRB095 17610 DRJ 45972 b and any other items recognized as medical equipment and supplies reimbursable under this Article and shall update such list on a quarterly basis, except that the acquisition costs of all prescription drugs shall be updated no less frequently than every 30 days as required by Section 5-5.12.
Within 90 days after the effective date of this amendatory Act of 1984, the Illinois Department shall establish a current list of acquisition costs for all prosthetic devices and any other items recognized as medical equipment and supplies reimbursable under this Article and shall update such list on a quarterly basis, except that the acquisition costs of all prescription drugs shall be updated no less frequently than every 30 days as required by Section 5-5.12.
The Illinois Department shall require all dispensers of medical services, other than an individual practitioner or group of practitioners, desiring to participate in the Medical Assistance program established under this Article to disclose all financial, beneficial, ownership, equity, surety or other interests in any and all firms, corporations, partnerships, associations, business enterprises, joint ventures, agencies, institutions or other legal entities providing any form of health care services in this State under this Article.
The Illinois Department shall require all dispensers of medical services, other than an individual practitioner or HB5192 Engrossed - 13 - LRB095 17610 DRJ 45972 b group of practitioners, desiring to participate in the Medical Assistance program established under this Article to disclose all financial, beneficial, ownership, equity, surety or other interests in any and all firms, corporations, partnerships, associations, business enterprises, joint ventures, agencies, institutions or other legal entities providing any form of health care services in this State under this Article.
The Illinois Department may require that all dispensers of medical services desiring to participate in the medical assistance program established under this Article disclose, under such terms and conditions as the Illinois Department may by rule establish, all inquiries from clients and attorneys regarding medical bills paid by the Illinois Department, which HB5192 - 13 - LRB095 17610 DRJ 45972 b inquiries could indicate potential existence of claims or liens for the Illinois Department.
The Illinois Department may require that all dispensers of medical services desiring to participate in the medical assistance program established under this Article disclose, under such terms and conditions as the Illinois Department may by rule establish, all inquiries from clients and attorneys regarding medical bills paid by the Illinois Department, which inquiries could indicate potential existence of claims or liens for the Illinois Department.
Such rules shall provide, but not be limited to, the following services:
Such rules shall provide, but not be HB5192 Engrossed - 14 - LRB095 17610 DRJ 45972 b limited to, the following services:
The Department shall execute, relative to the nursing home prescreening project, written inter-agency agreements with the HB5192 - 14 - LRB095 17610 DRJ 45972 b Department of Human Services and the Department on Aging, to effect the following:
The Department shall execute, relative to the nursing home prescreening project, written inter-agency agreements with the Department of Human Services and the Department on Aging, to effect the following:
The Illinois Department shall report annually to the General Assembly, no later than the second Friday in April of 1979 and each year thereafter, in regard to:
HB5192 Engrossed - 15 - LRB095 17610 DRJ 45972 b The Illinois Department shall report annually to the General Assembly, no later than the second Friday in April of 1979 and each year thereafter, in regard to:
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The report shall HB5192 - 15 - LRB095 17610 DRJ 45972 b include suggested legislation for consideration by the General Assembly.
The report shall include suggested legislation for consideration by the General Assembly.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under HB5192 Engrossed - 16 - LRB095 17610 DRJ 45972 b the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
8-28-07.) Section 5-10.
8-28-07.) Article 10.
The Counties Code is amended by changing Section 5-1069 as follows:
Breast Cancer Patients’ Access To Pain Relief HB5192 Engrossed - 17 - LRB095 17610 DRJ 45972 b Section 10-5.
(55 ILCS 5/5-1069) (from Ch.
34, par.
5-1069) Sec.
5-1069.
Group life, health, accident, hospital, and medical insurance.
(a) The county board of any county may arrange to provide, for the benefit of employees of the county, group life, health, accident, hospital, and medical insurance, or any one or any combination of those types of insurance, or the county board may self-insure, for the benefit of its employees, all or a portion of the employees’ group life, health, accident, hospital, and medical insurance, or any one or any combination HB5192 - 16 - LRB095 17610 DRJ 45972 b of those types of insurance, including a combination of self-insurance and other types of insurance authorized by this Section, provided that the county board complies with all other requirements of this Section.
The insurance may include provision for employees who rely on treatment by prayer or spiritual means alone for healing in accordance with the tenets and practice of a well recognized religious denomination.
The county board may provide for payment by the county of a portion or all of the premium or charge for the insurance with the employee paying the balance of the premium or charge, if any.
If the county board undertakes a plan under which the county pays only a portion of the premium or charge, the county board shall provide for withholding and deducting from the compensation of those employees who consent to join the plan the balance of the premium or charge for the insurance.
(b) If the county board does not provide for self-insurance or for a plan under which the county pays a portion or all of the premium or charge for a group insurance plan, the county board may provide for withholding and deducting from the compensation of those employees who consent thereto the total premium or charge for any group life, health, accident, hospital, and medical insurance.
(c) The county board may exercise the powers granted in this Section only if it provides for self-insurance or, where it makes arrangements to provide group insurance through an insurance carrier, if the kinds of group insurance are obtained HB5192 - 17 - LRB095 17610 DRJ 45972 b from an insurance company authorized to do business in the State of Illinois.
The county board may enact an ordinance prescribing the method of operation of the insurance program.
(d) If a county, including a home rule county, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer unless the county elects to provide mammograms itself under Section 5-1069.1.
The coverage shall be as follows:
(1) A baseline mammogram for women 35 to 39 years of age.
(2) An annual mammogram for women 40 years of age or older.
Those benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
For purposes of this subsection, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, and image receptors, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with 2 views for each breast.
The term also includes digital mammography.
The requirement that mammograms be included in health insurance coverage as provided in this subsection (d) is an exclusive power and function of HB5192 - 18 - LRB095 17610 DRJ 45972 b the State and is a denial and limitation under Article VII, Section 6, subsection (h) of the Illinois Constitution of home rule county powers.
A home rule county to which this subsection applies must comply with every provision of this subsection.
(e) The term "employees" as used in this Section includes elected or appointed officials but does not include temporary employees.
(f) The county board may, by ordinance, arrange to provide group life, health, accident, hospital, and medical insurance, or any one or a combination of those types of insurance, under this Section to retired former employees and retired former elected or appointed officials of the county.
(Source:
P.A.
90-7, eff.
6-10-97;
91-217, eff.
1-1-00.) Section 5-15.
The Illinois Municipal Code is amended by changing Section 10-4-2 as follows:
(65 ILCS 5/10-4-2) (from Ch.
24, par.
10-4-2) Sec.
10-4-2.
Group insurance.
(a) The corporate authorities of any municipality may arrange to provide, for the benefit of employees of the municipality, group life, health, accident, hospital, and medical insurance, or any one or any combination of those types of insurance, and may arrange to provide that insurance for the benefit of the spouses or dependents of those employees.
The insurance may include provision for employees or other insured HB5192 - 19 - LRB095 17610 DRJ 45972 b persons who rely on treatment by prayer or spiritual means alone for healing in accordance with the tenets and practice of a well recognized religious denomination.
The corporate authorities may provide for payment by the municipality of a portion of the premium or charge for the insurance with the employee paying the balance of the premium or charge.
If the corporate authorities undertake a plan under which the municipality pays a portion of the premium or charge, the corporate authorities shall provide for withholding and deducting from the compensation of those municipal employees who consent to join the plan the balance of the premium or charge for the insurance.
(b) If the corporate authorities do not provide for a plan under which the municipality pays a portion of the premium or charge for a group insurance plan, the corporate authorities may provide for withholding and deducting from the compensation of those employees who consent thereto the premium or charge for any group life, health, accident, hospital, and medical insurance.
(c) The corporate authorities may exercise the powers granted in this Section only if the kinds of group insurance are obtained from an insurance company authorized to do business in the State of Illinois, or are obtained through an intergovernmental joint self-insurance pool as authorized under the Intergovernmental Cooperation Act.
The corporate authorities may enact an ordinance prescribing the method of HB5192 - 20 - LRB095 17610 DRJ 45972 b operation of the insurance program.
(d) If a municipality, including a home rule municipality, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer unless the municipality elects to provide mammograms itself under Section 10-4-2.1.
The coverage shall be as follows:
(1) A baseline mammogram for women 35 to 39 years of age.
(2) An annual mammogram for women 40 years of age or older.
Those benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
For purposes of this subsection, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, and image receptors, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with 2 views for each breast.
The term also includes digital mammography.
The requirement that mammograms be included in health insurance coverage as provided in this subsection (d) 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 of home HB5192 - 21 - LRB095 17610 DRJ 45972 b rule municipality powers.
A home rule municipality to which this subsection applies must comply with every provision of this subsection.
(Source:
P.A.
90-7, eff.
6-10-97;
91-160, eff.
1-1-00.) Section 5-20.
The Illinois Insurance Code is amended by changing Section 356g as follows:
(215 ILCS 5/356g) (from Ch.
73, par.
968g) Sec.
356g.
Mammograms;
mastectomies.
(a) Every insurer shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of this State, coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer within the provisions of the policy, contract, or certificate.
The coverage shall be as follows:
(1) A baseline mammogram for women 35 to 39 years of age.
(2) An annual mammogram for women 40 years of age or older.
(3) A mammogram at the age and intervals considered medically necessary by the woman’s health care provider for women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, positive genetic testing, or other risk factors.
HB5192 - 22 - LRB095 17610 DRJ 45972 b (4) A comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue, when medically necessary as determined by a physician licensed to practice medicine in all of its branches.
These benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
For purposes of this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, and image receptors, and cassettes, receptor, with radiation exposure delivery of less than one 1 rad mid-breast, with per breast for 2 views for each of an average size breast.
The term also includes digital mammography.
(b) No policy of accident or health insurance that provides for the surgical procedure known as a mastectomy shall be issued, amended, delivered, or renewed in this State unless that coverage also provides for prosthetic devices or reconstructive surgery incident to the mastectomy.
Coverage for breast reconstruction in connection with a mastectomy shall include:
(1) reconstruction of the breast upon which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to HB5192 - 23 - LRB095 17610 DRJ 45972 b produce a symmetrical appearance;
and (3) prostheses and treatment for physical complications at all stages of mastectomy, including lymphedemas.
Care shall be determined in consultation with the attending physician and the patient.
The offered coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy, and all other terms and conditions applicable to other benefits.
When a mastectomy is performed and there is no evidence of malignancy then the offered coverage may be limited to the provision of prosthetic devices and reconstructive surgery to within 2 years after the date of the mastectomy.
As used in this Section, "mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician.
Written notice of the availability of coverage under this Section shall be delivered to the insured upon enrollment and annually thereafter.
An insurer may not deny to an insured eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of this Section.
An insurer may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce the provider to provide care to an insured in a manner inconsistent with this Section.
HB5192 - 24 - LRB095 17610 DRJ 45972 b (Source:
P.A.
94-121, eff.
7-6-05;
95-431, eff.
8-24-07.) Section 5-25.
The Health Maintenance Organization Act is amended by changing Section 4-6.1 as follows:
(215 ILCS 125/4-6.1) (from Ch.
111 1/2, par.
1408.7) Sec.
4-6.1.
Mammograms;
mastectomies.
(a) Every contract or evidence of coverage issued by a Health Maintenance Organization for persons who are residents of this State shall contain coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer.
The coverage shall be as follows:
(1) A baseline mammogram for women 35 to 39 years of age.
(2) An annual mammogram for women 40 years of age or older.
(3) A mammogram at the age and intervals considered medically necessary by the woman’s health care provider for women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, positive genetic testing, or other risk factors.
(4) A comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue, when medically necessary as determined by a physician licensed to practice HB5192 - 25 - LRB095 17610 DRJ 45972 b medicine in all of its branches.
These benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
For purposes of this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, and image receptors, and cassettes, receptor, with radiation exposure delivery of less than one 1 rad mid-breast, with per breast for 2 views for each of an average size breast.
The term also includes digital mammography.
(b) No contract or evidence of coverage issued by a health maintenance organization that provides for the surgical procedure known as a mastectomy shall be issued, amended, delivered, or renewed in this State on or after the effective date of this amendatory Act of the 92nd General Assembly unless that coverage also provides for prosthetic devices or reconstructive surgery incident to the mastectomy, providing that the mastectomy is performed after the effective date of this amendatory Act.
Coverage for breast reconstruction in connection with a mastectomy shall include:
(1) reconstruction of the breast upon which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance;
and HB5192 - 26 - LRB095 17610 DRJ 45972 b (3) prostheses and treatment for physical complications at all stages of mastectomy, including lymphedemas.
Care shall be determined in consultation with the attending physician and the patient.
The offered coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy and all other terms and conditions applicable to other benefits.
When a mastectomy is performed and there is no evidence of malignancy, then the offered coverage may be limited to the provision of prosthetic devices and reconstructive surgery to within 2 years after the date of the mastectomy.
As used in this Section, "mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician.
Written notice of the availability of coverage under this Section shall be delivered to the enrollee upon enrollment and annually thereafter.
A health maintenance organization may not deny to an enrollee eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of this Section.
A health maintenance organization may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce the provider to provide care to an insured in a manner inconsistent with this Section.
HB5192 - 27 - LRB095 17610 DRJ 45972 b (Source:
P.A.
94-121, eff.
7-6-05;
95-431, eff.
8-24-07.) Article 10.
Breast Cancer Patients’ Access To Pain Relief Section 10-5.
The provisions of this Section do not apply to short-term travel, accident-only, limited, or specified-disease policies, or to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or HB5192 - 28 - LRB095 17610 DRJ 45972 b any other similar coverage under State or federal governmental plans.
The provisions of this Section do not apply to short-term travel, accident-only, limited, or specified-disease policies, or to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under State or federal governmental plans.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under HB5192 Engrossed - 18 - LRB095 17610 DRJ 45972 b the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
(5 ILCS 375/6.11) Sec.
HB5192 Engrossed - 19 - LRB095 17610 DRJ 45972 b (5 ILCS 375/6.11) Sec.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other HB5192 Engrossed - 20 - LRB095 17610 DRJ 45972 b Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
If a county, including a home rule county, is a self-insurer for purposes of HB5192 - 29 - LRB095 17610 DRJ 45972 b 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.5, 356g.5-1, 356u, 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code.
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.5, 356g.5-1, 356u, 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code.
The requirement that health benefits be covered as provided in this Section 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.
The requirement that health benefits be covered as provided in this Section is an exclusive power and function of the State and is HB5192 Engrossed - 21 - LRB095 17610 DRJ 45972 b a denial and limitation under Article VII, Section 6, subsection (h) of the Illinois Constitution.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such HB5192 Engrossed - 22 - LRB095 17610 DRJ 45972 b definitions apply to agencies or agency heads under the jurisdiction of the Governor.
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.5, 356g.5-1, HB5192 - 30 - LRB095 17610 DRJ 45972 b 356u, 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code.
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.5, 356g.5-1, 356u, 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or HB5192 Engrossed - 23 - LRB095 17610 DRJ 45972 b promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
(105 ILCS 5/10-22.3f) Sec.
HB5192 Engrossed - 24 - LRB095 17610 DRJ 45972 b (105 ILCS 5/10-22.3f) Sec.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning HB5192 Engrossed - 25 - LRB095 17610 DRJ 45972 b contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
HB5192 - 31 - LRB095 17610 DRJ 45972 b (215 ILCS 125/5-3) (from Ch.
(215 ILCS 125/5-3) (from Ch.
(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":
(b) For purposes of the Illinois Insurance Code, except for Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health HB5192 Engrossed - 26 - LRB095 17610 DRJ 45972 b Maintenance Organizations in the following categories are deemed to be "domestic companies":
HB5192 - 32 - LRB095 17610 DRJ 45972 b (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;
(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;
(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 HB5192 Engrossed - 27 - LRB095 17610 DRJ 45972 b other acquisition of control;
(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 HB5192 - 33 - LRB095 17610 DRJ 45972 b combined operation for a period of 2 years;
(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;
(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.
(e) In considering any management contract or service HB5192 Engrossed - 28 - LRB095 17610 DRJ 45972 b 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 HB5192 - 34 - LRB095 17610 DRJ 45972 b 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:
(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:
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)).
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 HB5192 Engrossed - 29 - LRB095 17610 DRJ 45972 b 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 shall include a HB5192 - 35 - LRB095 17610 DRJ 45972 b 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.
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.
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 HB5192 Engrossed - 30 - LRB095 17610 DRJ 45972 b refund authorized under this Section.
(g) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
95-422, eff.
HB5192 Engrossed - 31 - LRB095 17610 DRJ 45972 b 95-422, eff.
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, 140, 143, 143c, HB5192 - 36 - LRB095 17610 DRJ 45972 b 149, 155.37, 354, 355.2, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10 356z.9, 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 Insurance Code.
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, 140, 143, 143c, 149, 155.37, 354, 355.2, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10 356z.9, 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 Insurance Code.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those HB5192 Engrossed - 32 - LRB095 17610 DRJ 45972 b suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
(a) Every insurer shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of this State, coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer within the provisions of the policy, contract, or certificate.
(a) Every insurer shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed HB5192 Engrossed - 33 - LRB095 17610 DRJ 45972 b for persons who are residents of this State, coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer within the provisions of the policy, contract, or certificate.
(2) An annual mammogram for women 40 years of age or HB5192 - 37 - LRB095 17610 DRJ 45972 b older.
(2) An annual mammogram for women 40 years of age or older.
For purposes of this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and image receptor, with radiation exposure delivery of less than 1 rad per breast for 2 views of an average size breast.
For purposes of this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and image receptor, with radiation HB5192 Engrossed - 34 - LRB095 17610 DRJ 45972 b exposure delivery of less than 1 rad per breast for 2 views of an average size breast.
(a-5) Coverage as described by subsection (a) shall be provided at no cost to the insured and shall not be subject to an annual or lifetime maximum benefit.
The term also includes digital mammography.
(a-10) When health care services are available through contracted providers and a person does not comply with plan provisions specific to the use of contracted providers, the HB5192 - 38 - LRB095 17610 DRJ 45972 b requirements of subsection (a-5) are not applicable.
(a-5) Coverage as described by subsection (a) shall be provided at no cost to the insured and shall not be applied to an annual or lifetime maximum benefit.
(a-10) When health care services are available through contracted providers and a person does not comply with plan provisions specific to the use of contracted providers, the requirements of subsection (a-5) are not applicable.
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance;
(2) surgery and reconstruction of the other breast to HB5192 Engrossed - 35 - LRB095 17610 DRJ 45972 b produce a symmetrical appearance;
The offered coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy, and all other terms and conditions applicable to HB5192 - 39 - LRB095 17610 DRJ 45972 b other benefits.
The offered coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy, and all other terms and conditions applicable to other benefits.
HB5192 Engrossed - 36 - LRB095 17610 DRJ 45972 b (c) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
8-24-07.) Section 15-10.
8-24-07.) HB5192 Engrossed - 37 - LRB095 17610 DRJ 45972 b Section 15-10.
The program of health benefits shall provide the post-mastectomy care benefits required to be covered by a HB5192 - 40 - LRB095 17610 DRJ 45972 b policy of accident and health insurance under Section 356t of the Illinois Insurance Code.
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.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action HB5192 Engrossed - 38 - LRB095 17610 DRJ 45972 b in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
(a) The county board of any county may arrange to provide, for the benefit of employees of the county, group life, health, accident, hospital, and medical insurance, or any one or any combination of those types of insurance, or the county board may self-insure, for the benefit of its employees, all or a portion of the employees’ group life, health, accident, hospital, and medical insurance, or any one or any combination of those types of insurance, including a combination of self-insurance and other types of insurance authorized by this Section, provided that the county board complies with all other HB5192 - 41 - LRB095 17610 DRJ 45972 b requirements of this Section.
(a) The county board of any county may arrange to provide, for the benefit of employees of the county, group life, health, accident, hospital, and medical insurance, or any one or any combination of those types of insurance, or the county board may self-insure, for the benefit of its employees, all or a HB5192 Engrossed - 39 - LRB095 17610 DRJ 45972 b portion of the employees’ group life, health, accident, hospital, and medical insurance, or any one or any combination of those types of insurance, including a combination of self-insurance and other types of insurance authorized by this Section, provided that the county board complies with all other requirements of this Section.
(c) The county board may exercise the powers granted in this Section only if it provides for self-insurance or, where it makes arrangements to provide group insurance through an insurance carrier, if the kinds of group insurance are obtained from an insurance company authorized to do business in the State of Illinois.
(c) The county board may exercise the powers granted in this Section only if it provides for self-insurance or, where HB5192 Engrossed - 40 - LRB095 17610 DRJ 45972 b it makes arrangements to provide group insurance through an insurance carrier, if the kinds of group insurance are obtained from an insurance company authorized to do business in the State of Illinois.
HB5192 - 42 - LRB095 17610 DRJ 45972 b (d) If a county, including a home rule county, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer unless the county elects to provide mammograms itself under Section 5-1069.1.
(d) If a county, including a home rule county, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer unless the county elects to provide mammograms itself under Section 5-1069.1.
Those benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
(3) A mammogram at the age and intervals considered medically necessary by the woman’s health care provider for women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, positive genetic testing, or other risk factors.
For purposes of this subsection, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, and image receptors, with an average radiation exposure delivery of less than one rad mid-breast, with 2 views for each breast.
(4) A comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue, when medically necessary as determined by a physician licensed to practice medicine in all of its branches.
The requirement that mammograms be included in health insurance coverage as provided in this subsection (d) 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 of home rule county powers.
HB5192 Engrossed - 41 - LRB095 17610 DRJ 45972 b Those benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
A home rule county to which this subsection applies must comply with every provision of this subsection.
For purposes of this subsection, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, and image receptor receptors, with an average radiation exposure delivery of less than one rad per breast for mid-breast, with 2 views of an average size for each breast.
HB5192 - 43 - LRB095 17610 DRJ 45972 b (e) The term "employees" as used in this Section includes elected or appointed officials but does not include temporary employees.
The term also includes digital mammography.
(d-5) Coverage as described by subsection (d) shall be provided at no cost to the insured and shall not be applied to an annual or lifetime maximum benefit.
(d-10) When health care services are available through contracted providers and a person does not comply with plan provisions specific to the use of contracted providers, the requirements of subsection (d-5) are not applicable.
When a person does not comply with plan provisions specific to the use of contracted providers, plan provisions specific to the use of non-contracted providers must be applied without distinction for coverage required by this Section and shall be at least as favorable as for other radiological examinations covered by the policy or contract.
(d-15) If a county, including a home rule county, is a self-insurer for purposes of providing health insurance HB5192 Engrossed - 42 - LRB095 17610 DRJ 45972 b coverage for its employees, the insurance coverage shall include mastectomy coverage, which includes coverage for prosthetic devices or reconstructive surgery incident to the mastectomy.
Coverage for breast reconstruction in connection with a mastectomy shall include:
(1) reconstruction of the breast upon which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance;
and (3) prostheses and treatment for physical complications at all stages of mastectomy, including lymphedemas.
Care shall be determined in consultation with the attending physician and the patient.
The offered coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy, and all other terms and conditions applicable to other benefits.
When a mastectomy is performed and there is no evidence of malignancy then the offered coverage may be limited to the provision of prosthetic devices and reconstructive surgery to within 2 years after the date of the mastectomy.
As used in this Section, "mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician.
A county, including a home rule county, that is a self-insurer for purposes of providing health insurance HB5192 Engrossed - 43 - LRB095 17610 DRJ 45972 b coverage for its employees, may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce the provider to provide care to an insured in a manner inconsistent with this Section.
(d-20) The requirement that mammograms be included in health insurance coverage as provided in subsections this subsection (d) through (d-15) 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 of home rule county powers.
A home rule county to which subsections (d) through (d-15) apply this subsection applies must comply with every provision of those subsections this subsection.
(e) The term "employees" as used in this Section includes elected or appointed officials but does not include temporary employees.
(g) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions HB5192 Engrossed - 44 - LRB095 17610 DRJ 45972 b of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
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, 356u, 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code.
If a county, including a home rule county, is a self-insurer for purposes of providing health insurance coverage for its employees, the HB5192 Engrossed - 45 - LRB095 17610 DRJ 45972 b 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, 356u, 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other HB5192 Engrossed - 46 - LRB095 17610 DRJ 45972 b Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
HB5192 - 44 - LRB095 17610 DRJ 45972 b 95-520, eff.
95-520, eff.
The insurance may include provision for employees or other insured persons who rely on treatment by prayer or spiritual means alone for healing in accordance with the tenets and practice of a well recognized religious denomination.
The insurance may include provision for employees or other insured persons who rely on treatment by prayer or spiritual means alone for healing in accordance with the tenets and practice of HB5192 Engrossed - 47 - LRB095 17610 DRJ 45972 b a well recognized religious denomination.
HB5192 - 45 - LRB095 17610 DRJ 45972 b (b) If the corporate authorities do not provide for a plan under which the municipality pays a portion of the premium or charge for a group insurance plan, the corporate authorities may provide for withholding and deducting from the compensation of those employees who consent thereto the premium or charge for any group life, health, accident, hospital, and medical insurance.
(b) If the corporate authorities do not provide for a plan under which the municipality pays a portion of the premium or charge for a group insurance plan, the corporate authorities may provide for withholding and deducting from the compensation of those employees who consent thereto the premium or charge for any group life, health, accident, hospital, and medical insurance.
(d) If a municipality, including a home rule municipality, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer unless the municipality elects to provide mammograms itself under Section 10-4-2.1.
(d) If a municipality, including a home rule municipality, HB5192 Engrossed - 48 - LRB095 17610 DRJ 45972 b is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer unless the municipality elects to provide mammograms itself under Section 10-4-2.1.
HB5192 - 46 - LRB095 17610 DRJ 45972 b Those benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
(3) A mammogram at the age and intervals considered medically necessary by the woman’s health care provider for women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, positive genetic testing, or other risk factors.
For purposes of this subsection, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, and image receptors, with an average radiation exposure delivery of less than one rad mid-breast, with 2 views for each breast.
(4) A comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue, when medically necessary as determined by a physician licensed to practice medicine in all of its branches.
The requirement that mammograms be included in health insurance coverage as provided in this subsection (d) 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 of home rule municipality powers.
Those benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
A home rule municipality to which this subsection applies must comply with every provision of this subsection.
For purposes of this subsection, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, HB5192 Engrossed - 49 - LRB095 17610 DRJ 45972 b filter, compression device, screens, and image receptor receptors, with an average radiation exposure delivery of less than one rad per breast for mid-breast, with 2 views of an average size for each breast.
The term also includes digital mammography.
(d-5) Coverage as described by subsection (d) shall be provided at no cost to the insured and shall not be applied to an annual or lifetime maximum benefit.
(d-10) When health care services are available through contracted providers and a person does not comply with plan provisions specific to the use of contracted providers, the requirements of subsection (d-5) are not applicable.
When a person does not comply with plan provisions specific to the use of contracted providers, plan provisions specific to the use of non-contracted providers must be applied without distinction for coverage required by this Section and shall be at least as favorable as for other radiological examinations covered by the policy or contract.
(d-15) If a municipality, including a home rule municipality, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include mastectomy coverage, which includes coverage for prosthetic devices or reconstructive surgery incident to the mastectomy.
Coverage for breast reconstruction in connection with a mastectomy shall include:
(1) reconstruction of the breast upon which the HB5192 Engrossed - 50 - LRB095 17610 DRJ 45972 b mastectomy has been performed;
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance;
and (3) prostheses and treatment for physical complications at all stages of mastectomy, including lymphedemas.
Care shall be determined in consultation with the attending physician and the patient.
The offered coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy, and all other terms and conditions applicable to other benefits.
When a mastectomy is performed and there is no evidence of malignancy then the offered coverage may be limited to the provision of prosthetic devices and reconstructive surgery to within 2 years after the date of the mastectomy.
As used in this Section, "mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician.
A municipality, including a home rule municipality, that is a self-insurer for purposes of providing health insurance coverage for its employees, may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives (monetary or otherwise) to an attending provider to induce the provider to provide care to an insured in a manner inconsistent with this Section.
(d-20) The requirement that mammograms be included in HB5192 Engrossed - 51 - LRB095 17610 DRJ 45972 b health insurance coverage as provided in subsections this subsection (d) through (d-15) 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 of home rule municipality powers.
A home rule municipality to which subsections (d) through (d-15) apply this subsection applies must comply with every provision of through subsections this subsection.
(e) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning HB5192 Engrossed - 52 - LRB095 17610 DRJ 45972 b contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
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, 356u, HB5192 - 47 - LRB095 17610 DRJ 45972 b 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code.
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, 356u, 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or HB5192 Engrossed - 53 - LRB095 17610 DRJ 45972 b promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
(105 ILCS 5/10-22.3f) Sec.
HB5192 Engrossed - 54 - LRB095 17610 DRJ 45972 b (105 ILCS 5/10-22.3f) Sec.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning HB5192 Engrossed - 55 - LRB095 17610 DRJ 45972 b contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
HB5192 - 48 - LRB095 17610 DRJ 45972 b (215 ILCS 125/4-6.1) (from Ch.
(215 ILCS 125/4-6.1) (from Ch.
(3) A mammogram at the age and intervals considered medically necessary by the woman’s health care provider for women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, positive genetic testing, or other risk factors.
(3) A mammogram at the age and intervals considered medically necessary by the woman’s health care provider for HB5192 Engrossed - 56 - LRB095 17610 DRJ 45972 b women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, positive genetic testing, or other risk factors.
For purposes of this Section, "low-dose mammography" means the x-ray HB5192 - 49 - LRB095 17610 DRJ 45972 b examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and image receptor, with radiation exposure delivery of less than 1 rad per breast for 2 views of an average size breast.
For purposes of this Section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, and image receptor, with radiation exposure delivery of less than 1 rad per breast for 2 views of an average size breast.
(a-5) Coverage as described in subsection (a) shall be provided at no cost to the enrollee, shall not be subject to an annual or lifetime maximum benefit, and shall be at least as favorable as for other radiological examinations covered by the policy or contract.
The term also includes digital mammography.
(b) No contract or evidence of coverage issued by a health maintenance organization that provides for the surgical procedure known as a mastectomy shall be issued, amended, delivered, or renewed in this State on or after the effective date of this amendatory Act of the 92nd General Assembly unless that coverage also provides for prosthetic devices or reconstructive surgery incident to the mastectomy, providing that the mastectomy is performed after the effective date of this amendatory Act.
(a-5) Coverage as described in subsection (a) shall be provided at no cost to the enrollee and shall not be applied to an annual or lifetime maximum benefit.
(b) No contract or evidence of coverage issued by a health maintenance organization that provides for the surgical procedure known as a mastectomy shall be issued, amended, delivered, or renewed in this State on or after the effective date of this amendatory Act of the 92nd General Assembly unless HB5192 Engrossed - 57 - LRB095 17610 DRJ 45972 b that coverage also provides for prosthetic devices or reconstructive surgery incident to the mastectomy, providing that the mastectomy is performed after the effective date of this amendatory Act.
and (3) prostheses and treatment for physical complications at all stages of mastectomy, including HB5192 - 50 - LRB095 17610 DRJ 45972 b lymphedemas.
and (3) prostheses and treatment for physical complications at all stages of mastectomy, including lymphedemas.
Written notice of the availability of coverage under this Section shall be delivered to the enrollee upon enrollment and annually thereafter.
Written notice of the availability of coverage under this Section shall be delivered to the enrollee upon enrollment and HB5192 Engrossed - 58 - LRB095 17610 DRJ 45972 b annually thereafter.
(c) Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of HB5192 Engrossed - 59 - LRB095 17610 DRJ 45972 b the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
8-24-07.) HB5192 - 51 - LRB095 17610 DRJ 45972 b Section 15-35.
8-24-07.) Section 15-35.
Notwithstanding any other rulemaking authority that may exist, neither the Governor nor any agency or agency head under the jurisdiction of the Governor has any authority to make or promulgate rules to implement or enforce the provisions of this HB5192 Engrossed - 60 - LRB095 17610 DRJ 45972 b amendatory Act of the 95th General Assembly.
If, however, the Governor believes that rules are necessary to implement or enforce the provisions of this amendatory Act of the 95th General Assembly, the Governor may suggest rules to the General Assembly by filing them with the Clerk of the House and the Secretary of the Senate and by requesting that the General Assembly authorize such rulemaking by law, enact those suggested rules into law, or take any other appropriate action in the General Assembly’s discretion.
Nothing contained in this amendatory Act of the 95th General Assembly shall be interpreted to grant rulemaking authority under any other Illinois statute where such authority is not otherwise explicitly given.
For the purposes of this amendatory Act of the 95th General Assembly, "rules" is given the meaning contained in Section 1-70 of the Illinois Administrative Procedure Act, and "agency" and "agency head" are given the meanings contained in Sections 1-20 and 1-25 of the Illinois Administrative Procedure Act to the extent that such definitions apply to agencies or agency heads under the jurisdiction of the Governor.
HB5192 - 52 - LRB095 17610 DRJ 45972 b INDEX Statutes amended in order of appearance 305 ILCS 5/5-5 from Ch.
23, par.
5-5 55 ILCS 5/5-1069 from Ch.
34, par.
5-1069 65 ILCS 5/10-4-2 from Ch.
24, par.
10-4-2 215 ILCS 5/356g from Ch.
73, par.
968g 215 ILCS 125/4-6.1 from Ch.
111 1/2, par.
1408.7 215 ILCS 5/356g.5-1 new 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 125/5-3 from Ch.
111 1/2, par.
1411.2 215 ILCS 165/10 from Ch.
32, par.
604 215 ILCS 5/356g from Ch.
73, par.
968g 5 ILCS 375/6.11 55 ILCS 5/5-1069 from Ch.
34, par.
5-1069 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2 from Ch.
24, par.
10-4-2 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 125/4-6.1 from Ch.
111 1/2, par.
1408.7 215 ILCS 165/10 from Ch.
32, par.
604
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Action History

  1. Session Sine Die

  2. Added Co-Sponsor Rep. Arthur L. Turner

  3. Added Co-Sponsor Rep. Harry Osterman

  4. Rule 19(b) / Re-referred to Rules Committee

  5. Added Co-Sponsor Rep. Luis Arroyo

  6. Placed on Calendar Order of Concurrence Senate Amendment(s) 1

  7. Arrived in House

  8. Third Reading - Passed; 055-000-000

  9. Added as Alternate Co-Sponsor Sen. Donne E. Trotter

  10. Added as Alternate Co-Sponsor Sen. John M. Sullivan

  11. Rule 2-10 Third Reading Deadline Established As May 31, 2008

  12. Added as Alternate Co-Sponsor Sen. John J. Millner

  13. Placed on Calendar Order of 3rd Reading May 23, 2008

  14. Second Reading

  15. Added as Alternate Co-Sponsor Sen. Kirk W. Dillard

  16. Placed on Calendar Order of 2nd Reading May 23, 2008

  17. Do Pass as Amended Human Services; 009-000-000

  18. Senate Committee Amendment No. 1 Adopted

  19. Added as Alternate Co-Sponsor Sen. Dan Kotowski

  20. Senate Committee Amendment No. 1 Rules Refers to Human Services

  21. Added as Alternate Co-Sponsor Sen. Dan Cronin

  22. Added as Alternate Co-Sponsor Sen. Kimberly A. Lightford

  23. Added as Alternate Co-Sponsor Sen. Ira I. Silverstein

  24. Senate Committee Amendment No. 1 Referred to Rules

  25. Senate Committee Amendment No. 1 Filed with Secretary by Sen. Jacqueline Y. Collins

  26. Rule 2-10 Committee Deadline Established As May 22, 2008; Substantive House Bills Out of Committee

  27. Assigned to Human Services

  28. Added as Alternate Co-Sponsor Sen. Christine Radogno

  29. Added as Alternate Co-Sponsor Sen. Pamela J. Althoff

  30. Added as Alternate Co-Sponsor Sen. Gary Forby

  31. Added as Alternate Co-Sponsor Sen. Carole Pankau

  32. Added as Alternate Co-Sponsor Sen. Linda Holmes

  33. Added as Alternate Co-Sponsor Sen. Michael Noland

  34. Added as Alternate Co-Sponsor Sen. Jeffrey M. Schoenberg

  35. Added as Alternate Co-Sponsor Sen. Rickey R. Hendon

  36. Added as Alternate Co-Sponsor Sen. Kwame Raoul

  37. Added as Alternate Co-Sponsor Sen. William Delgado

  38. Added as Alternate Co-Sponsor Sen. Don Harmon

  39. Added as Alternate Co-Sponsor Sen. Debbie DeFrancesco Halvorson

  40. Referred to Rules

  41. First Reading

  42. Added as Alternate Chief Co-Sponsor Sen. Mattie Hunter

  43. Added as Alternate Chief Co-Sponsor Sen. Iris Y. Martinez

  44. Added as Alternate Chief Co-Sponsor Sen. David Koehler

  45. Added as Alternate Chief Co-Sponsor Sen. Heather Steans

  46. Chief Senate Sponsor Sen. Jacqueline Y. Collins

  47. Placed on Calendar Order of First Reading

  48. Arrive in Senate

  49. Added Co-Sponsor Rep. Cynthia Soto

  50. Added Co-Sponsor Rep. Elga L. Jefferies

  51. Third Reading - Short Debate - Passed 110-000-000

  52. Placed on Calendar Order of 3rd Reading - Short Debate

  53. Second Reading - Short Debate

  54. Added Co-Sponsor Rep. Robert W. Pritchard

  55. Added Co-Sponsor Rep. Bob Biggins

  56. Added Co-Sponsor Rep. Harry R. Ramey, Jr.

  57. Added Co-Sponsor Rep. Sandra M. Pihos

  58. Added Co-Sponsor Rep. Paul D. Froehlich

  59. Added Co-Sponsor Rep. Jack D. Franks

  60. Added Co-Sponsor Rep. Daniel V. Beiser

  61. Added Co-Sponsor Rep. Linda Chapa LaVia

  62. Added Co-Sponsor Rep. John E. Bradley

  63. Added Co-Sponsor Rep. Renée Kosel

  64. Added Co-Sponsor Rep. Mike Bost

  65. Added Co-Sponsor Rep. Rich Brauer

  66. Added Co-Sponsor Rep. Raymond Poe

  67. Added Co-Sponsor Rep. Michael Tryon

  68. Added Co-Sponsor Rep. James H. Meyer

  69. Added Co-Sponsor Rep. Dennis M. Reboletti

  70. Added Co-Sponsor Rep. Maria Antonia Berrios

  71. Added Co-Sponsor Rep. Susana A Mendoza

  72. Added Co-Sponsor Rep. Brent Hassert

  73. Added Co-Sponsor Rep. Tom Cross

  74. Added Co-Sponsor Rep. JoAnn D. Osmond

  75. Added Co-Sponsor Rep. Ronald A. Wait

  76. Added Co-Sponsor Rep. Rosemary Mulligan

  77. Placed on Calendar 2nd Reading - Short Debate

  78. Do Pass as Amended / Short Debate Health & Healthcare Disparities Committee; 010-000-000

  79. House Committee Amendment No. 2 Adopted in Health & Healthcare Disparities Committee; by Voice Vote

  80. House Committee Amendment No. 1 Adopted in Health & Healthcare Disparities Committee; by Voice Vote

  81. House Committee Amendment No. 2 Filed with Clerk by Health & Healthcare Disparities Committee

  82. House Committee Amendment No. 1 Filed with Clerk by Health & Healthcare Disparities Committee

  83. Re-assigned to Health & Healthcare Disparities Committee

  84. Assigned to Health Care Availability and Access Committee

  85. Added Co-Sponsor Rep. David R. Leitch

  86. Added Co-Sponsor Rep. Sara Feigenholtz

  87. Added Co-Sponsor Rep. Eddie Washington

  88. Added Co-Sponsor Rep. Elaine Nekritz

  89. Added Co-Sponsor Rep. George Scully, Jr.

  90. Added Co-Sponsor Rep. Joseph M. Lyons

  91. Added Co-Sponsor Rep. Lou Lang

  92. Added Co-Sponsor Rep. Elizabeth Coulson

  93. Added Co-Sponsor Rep. Constance A. Howard

  94. Added Co-Sponsor Rep. Karen A. Yarbrough

  95. Added Co-Sponsor Rep. Karen May

  96. Added Co-Sponsor Rep. Naomi D. Jakobsson

  97. Added Co-Sponsor Rep. Kathleen A. Ryg

  98. Added Chief Co-Sponsor Rep. Monique D. Davis

  99. Added Co-Sponsor Rep. Al Riley

  100. Added Chief Co-Sponsor Rep. Mike Boland

  101. Added Chief Co-Sponsor Rep. LaShawn K. Ford

  102. Referred to Rules Committee

  103. First Reading

  104. Added Chief Co-Sponsor Rep. Barbara Flynn Currie

  105. Filed with the Clerk by Rep. Greg Harris

Sponsors

  • Greg Harris · Cosponsor
  • Debbie DeFrancesco Halvorson · Cosponsor
  • Don Harmon · Cosponsor
  • Kwame Raoul · Cosponsor
  • Rickey R. Hendon · Cosponsor
  • Jeffrey M. Schoenberg · Cosponsor
  • Michael Noland · Cosponsor
  • Linda Holmes · Cosponsor
  • Carole Pankau · Cosponsor
  • Gary Forby · Cosponsor
  • Pamela J. Althoff · Cosponsor
  • Christine Radogno · Cosponsor
  • Ira I. Silverstein · Cosponsor
  • Kimberly A. Lightford · Cosponsor
  • Dan Cronin · Cosponsor
  • Dan Kotowski · Cosponsor
  • Kirk W. Dillard · Cosponsor
  • John J. Millner · Cosponsor
  • John M. Sullivan · Cosponsor
  • Donne E. Trotter · Cosponsor
  • Eva-Dina Delgado · Cosponsor

Sponsorship breakdown

Export CSV (upgrade) →

0 sponsors · 21 co-sponsors · 162 not signed on

Sponsors (0)

None.

Co-sponsors (21)

  • Greg Harris
  • Debbie DeFrancesco Halvorson
  • Don Harmon Democrat
  • Kwame Raoul
  • Rickey R. Hendon
  • Jeffrey M. Schoenberg
  • Michael Noland
  • Linda Holmes Democrat
  • Carole Pankau
  • Gary Forby
  • Pamela J. Althoff
  • Christine Radogno
  • Ira I. Silverstein
  • Kimberly A. Lightford Democrat
  • Dan Cronin
  • Dan Kotowski
  • Kirk W. Dillard
  • John J. Millner
  • John M. Sullivan
  • Donne E. Trotter
  • Eva-Dina Delgado Democrat

Not signed on (162)

162 members have not signed on to this bill.

Show all 162 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Third Reading

Passed 55 Yea · 0 Nay · 4 Other
Party YeaNayPresentNot Voting
Unaffiliated 45004
Democrat 9000
Republican 1000
Total 55004
% of votes cast 93%0%0%7%
How each member voted (59)
Member Party Vote
Haine — Yea
Halvorson — Yea
Hultgren — Yea
Lauzen — Yea
Link — Yea
Schoenberg — Yea
Brady — Yea
Dillard — Yea
Forby — Yea
Frerichs — Yea
Garrett — Yea
Meeks — Yea
Sullivan — Yea
Millner — Yea
Noland — Yea
Pankau — Yea
Radogno — Yea
Cullerton — Yea
Watson — Yea
Jacobs — Yea
Silverstein — Not Voting
Jones, J. — Yea
Munoz — Not Voting
Demuzio — Not Voting
Trotter — Yea
Viverito — Not Voting
Wilhelmi — Yea
Clayborne — Yea
Crotty — Yea
Dahl — Yea
DeLeo — Yea
Hendon — Yea
Kotowski — Yea
Peterson — Yea
Raoul — Yea
Righter — Yea
Risinger — Yea
Rutherford — Yea
Sandoval — Yea
Steans — Yea
Luechtefeld — Yea
Maloney — Yea
Althoff — Yea
Martinez — Yea
Bivins — Yea
Bomke — Yea
Bond — Yea
Burzynski — Yea
Cronin — Yea
David Koehler Democrat Yea
Don Harmon Democrat Yea
Emil Jones, III Democrat Yea
Eva-Dina Delgado Democrat Yea
Kimberly A. Lightford Democrat Yea
Lakesia Collins Democrat Yea
Laura M. Murphy Democrat Yea
Linda Holmes Democrat Yea
Mattie Hunter Democrat Yea
Dave Syverson Republican Yea

Official roll call →

Third Reading

Passed 110 Yea · 0 Nay · 8 Other
Party YeaNayPresentNot Voting
Unaffiliated 97008
Republican 4000
Democrat 9000
Total 110008
% of votes cast 93%0%0%7%
How each member voted (118)
Member Party Vote
Granberg — Not Voting
Holbrook — Yea
Nekritz — Yea
Jefferies — Yea
Jefferson — Yea
Lang — Yea
Dugan — Yea
Dunkin — Yea
Leitch — Yea
Lindner — Yea
Reitz — Yea
McAuliffe — Yea
McCarthy — Yea
Lyons — Yea
Mendoza — Yea
Meyer — Yea
Moffitt — Yea
Molaro — Yea
Munson — Yea
Myers — Yea
Schock — Yea
Soto — Yea
Tryon — Yea
McGuire — Yea
Turner — Yea
Verschoore — Yea
Bradley, John — Yea
Brady — Yea
Mitchell, Bill — Yea
Mitchell, Jerry — Yea
Burke — Yea
Sullivan — Yea
Hannig — Yea
Harris — Yea
Hernandez — Yea
Coladipietro — Yea
Cole — Yea
Durkin — Yea
Eddy — Yea
Flider — Yea
Flowers — Yea
Fortner — Yea
Franks — Yea
Fritchey — Yea
Froehlich — Yea
Golar — Yea
Gordon — Yea
Graham — Yea
Hamos — Yea
Hassert — Yea
Madigan — Yea
Howard — Yea
Davis, Monique — Yea
Patterson — Yea
Phelps — Yea
Bradley, Richard — Not Voting
Watson — Not Voting
Pihos — Not Voting
Wait — Yea
Washington — Not Voting
Winters — Yea
Yarbrough — Yea
Colvin — Yea
Coulson — Yea
Cross — Yea
Cultra — Yea
Currie — Yea
D'Amico — Yea
Dunn — Not Voting
Jakobsson — Yea
Kosel — Yea
Osmond — Yea
Osterman — Not Voting
Poe — Yea
Pritchard — Yea
Ramey — Yea
Reboletti — Yea
Reis — Yea
Riley — Yea
Ryg — Yea
Sacia — Yea
Saviano — Yea
Schmitz — Yea
Scully — Yea
Sommer — Yea
Younge — Yea
Krause — Yea
Acevedo — Yea
Arroyo — Yea
Bassi — Yea
Beaubien — Yea
Beiser — Yea
Mathias — Yea
Bellock — Yea
Berrios — Yea
Biggins — Yea
Mautino — Yea
Black — Not Voting
Boland — Yea
May — Yea
Bost — Yea
Brauer — Yea
Brosnahan — Yea
Mulligan — Yea
Chapa LaVia — Yea
Fred Crespo Democrat Yea
Jay Hoffman Democrat Yea
La Shawn K. Ford Democrat Yea
Lakesia Collins Democrat Yea
Nicholas K. Smith Democrat Yea
Patrick J. Joyce Democrat Yea
Robert "Bob" Rita Democrat Yea
Sara Feigenholtz Democrat Yea
William "Will" Davis Democrat Yea
Brad Stephens Republican Yea
Chapin Rose Republican Yea
Chris Miller Republican Yea
Jil Tracy Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does HB 5192 do?
Amends the Illinois Public Aid Code, the Illinois Insurance Code, and other Acts. Provides that on and after July 1, 2008, screening and diagnostic mammography shall be reimbursed under the medical assistance program at the same rate as the Medicare program's rates, including the increased reimbursement for digital mammography. Requires the Department of Healthcare and Family Services to take certain actions in relation to breast cancer screening and treatment, including establishment of bonus payments to mammography facilities meeting certain standards, a rate methodology for certain providers, and a performance goal for primary care providers; also requires the Department to establish a case-management or patient-navigation pilot program. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act must provide coverage for all medically necessary pain medication and pain therapy related to the treatment of breast cancer on the same terms and conditions that are generally applicable to coverage for other conditions. Provides that mandatory insurance coverage relating to mammography shall be provided at no cost to the insured and shall not be subject to an annual or lifetime maximum benefit. Makes other changes in relation to mammography coverage, and makes these changes to the Illinois Insurance Code also applicable to the State Employees Group Insurance Act of 1971, the Health Maintenance Organization Act, and other Acts. Sets forth a statement of legislative intent and provides that the bill's provisions may be referred to as the Reducing Breast Cancer Disparities Act. Effective immediately.
Who sponsors HB 5192?
HB 5192 is sponsored by Greg Harris, Debbie DeFrancesco Halvorson, Don Harmon (Democrat), Kwame Raoul, Rickey R. Hendon, Jeffrey M. Schoenberg, Michael Noland, Linda Holmes (Democrat), Carole Pankau, Gary Forby, Pamela J. Althoff, Christine Radogno, Ira I. Silverstein, Kimberly A. Lightford (Democrat), Dan Cronin, Dan Kotowski, Kirk W. Dillard, John J. Millner, John M. Sullivan, Donne E. Trotter, and Eva-Dina Delgado (Democrat).
What is the current status of HB 5192?
This bill died with 95th Regular Session. It reached “Passed House” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track HB 5192?
Track HB 5192 free on One Click Politics — get push/email alerts when it moves.

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