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| Public Act 103-0703 | ||||
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AN ACT concerning regulation. | ||||
Be it enacted by the People of the State of Illinois, | ||||
represented in the General Assembly: | ||||
Section 5. The Illinois Insurance Code is amended by | ||||
changing Section 356z.56 as follows: | ||||
(215 ILCS 5/356z.56) | ||||
Sec. 356z.56. Coverage for hormonal and non-hormonal | ||||
hormone therapy to treat menopause. A group or individual | ||||
policy of accident and health insurance or a managed care plan | ||||
that is amended, delivered, issued, or renewed in this State | ||||
on or after January 1, 2024 shall provide coverage for | ||||
medically necessary hormone therapy treatment to treat | ||||
menopause that has been induced by a hysterectomy. This | ||||
coverage applies only to coverage provided on or after January | ||||
1, 2024 and before January 1, 2026. | ||||
A group or individual policy of accident and health | ||||
insurance or a managed care plan that is amended, delivered, | ||||
issued, or renewed on or after January 1, 2026 shall provide | ||||
coverage for medically necessary hormonal and non-hormonal | ||||
therapy to treat menopausal symptoms if the therapy is | ||||
recommended by a qualified health care provider who is | ||||
licensed, accredited, or certified under Illinois law and the | ||||
therapy has been proven safe and effective in peer-reviewed | ||||
scientific studies. Coverage for therapy to treat menopausal | ||
symptoms shall include all federal Food and Drug | ||
Administration-approved modalities of hormonal and | ||
non-hormonal administration, including, but not limited to, | ||
oral, transdermal, topical, and vaginal rings. | ||
(Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23.) | ||
Section 10. The Illinois Public Aid Code is amended by | ||
changing Section 5-16.8 and by adding Section 5-52 as follows: | ||
(305 ILCS 5/5-16.8) | ||
Sec. 5-16.8. Required health benefits. The medical | ||
assistance program shall (i) provide the post-mastectomy care | ||
benefits required to be covered by a policy of accident and | ||
health insurance under Section 356t and the coverage required | ||
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, | ||
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | ||
356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and | ||
356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code, | ||
(ii) be subject to the provisions of Sections 356z.19, | ||
356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois | ||
Insurance Code, and (iii) be subject to the provisions of | ||
subsection (d-5) of Section 10 of the Network Adequacy and | ||
Transparency Act. | ||
The Department, by rule, shall adopt a model similar to | ||
the requirements of Section 356z.39 of the Illinois Insurance | ||
Code. | ||
On and after July 1, 2012, the Department shall reduce any | ||
rate of reimbursement for services or other payments or alter | ||
any methodologies authorized by this Code to reduce any rate | ||
of reimbursement for services or other payments in accordance | ||
with Section 5-5e. | ||
To ensure full access to the benefits set forth in this | ||
Section, on and after January 1, 2016, the Department shall | ||
ensure that provider and hospital reimbursement for | ||
post-mastectomy care benefits required under this Section are | ||
no lower than the Medicare reimbursement rate. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. | ||
1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, | ||
eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | ||
1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.) | ||
(305 ILCS 5/5-52 new) | ||
Sec. 5-52. Coverage for hormonal therapy to treat | ||
menopause. The medical assistance program shall provide | ||
coverage for medically necessary hormone therapy treatment to | ||
treat menopause that has been induced by a hysterectomy. | ||
Section 99. Effective date. This Act takes effect January | ||
1, 2026. | ||