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| Public Act 103-0914 | ||||
| ||||
AN ACT concerning regulation. | ||||
Be it enacted by the People of the State of Illinois, | ||||
represented in the General Assembly: | ||||
Section 5. The State Employees Group Insurance Act of 1971 | ||||
is amended by changing Section 6.11 as follows: | ||||
(5 ILCS 375/6.11) | ||||
Sec. 6.11. Required health benefits; Illinois Insurance | ||||
Code requirements. 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. The program of | ||||
health benefits shall provide the coverage required under | ||||
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, | ||||
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, | ||||
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | ||||
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | ||||
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||||
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, | ||||
356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, | ||||
and 356z.70 of the Illinois Insurance Code. The program of | ||||
health benefits must comply with Sections 155.22a, 155.37, | ||||
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | ||||
Illinois Insurance Code. The program of health benefits shall | ||||
provide the coverage required under Section 356m of the | ||
Illinois Insurance Code and, for the employees of the State | ||
Employee Group Insurance Program only, the coverage as also | ||
provided in Section 6.11B of this Act. The Department of | ||
Insurance shall enforce the requirements of this Section with | ||
respect to Sections 370c and 370c.1 of the Illinois Insurance | ||
Code; all other requirements of this Section shall be enforced | ||
by the Department of Central Management Services. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | ||
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | ||
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | ||
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | ||
8-11-23; revised 8-29-23.) | ||
Section 10. The Counties Code is amended by changing | ||
Section 5-1069.3 as follows: | ||
(55 ILCS 5/5-1069.3) | ||
Sec. 5-1069.3. Required health benefits. 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, 356g.5-1, 356q, 356u, 356u.10, | ||
356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, | ||
356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, | ||
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, | ||
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | ||
356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70 | ||
of the Illinois Insurance Code. The coverage shall comply with | ||
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | ||
Insurance Code. The Department of Insurance shall enforce the | ||
requirements of this Section. 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. A home rule county to which this | ||
Section applies must comply with every provision of this | ||
Section. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||
102-816, eff. 1-1-23; 102-860, 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; 103-445, eff. 1-1-24; | ||
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||
8-29-23.) | ||
Section 15. The Illinois Municipal Code is amended by | ||
changing Section 10-4-2.3 as follows: | ||
(65 ILCS 5/10-4-2.3) | ||
Sec. 10-4-2.3. Required health benefits. 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, 356g.5-1, 356q, 356u, 356u.10, 356w, 356x, 356z.4, | ||
356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||
356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||
356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62, | ||
356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois | ||
Insurance Code. The coverage shall comply with Sections | ||
155.22a, 355b, 356z.19, and 370c of the Illinois Insurance | ||
Code. The Department of Insurance shall enforce the | ||
requirements of this Section. The requirement that health | ||
benefits be covered as provided in this 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. A home rule municipality to which this Section | ||
applies must comply with every provision of this Section. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||
102-816, eff. 1-1-23; 102-860, 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; 103-445, eff. 1-1-24; | ||
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||
8-29-23.) | ||
Section 20. The School Code is amended by changing Section | ||
10-22.3f as follows: | ||
(105 ILCS 5/10-22.3f) | ||
Sec. 10-22.3f. Required health benefits. Insurance | ||
protection and benefits for employees shall 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, 356g.5, 356g.5-1, | ||
356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, | ||
356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, | ||
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | ||
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, | ||
and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and | ||
356z.70 of the Illinois Insurance Code. Insurance policies | ||
shall comply with Section 356z.19 of the Illinois Insurance | ||
Code. The coverage shall comply with Sections 155.22a, 355b, | ||
and 370c of the Illinois Insurance Code. The Department of | ||
Insurance shall enforce the requirements of this Section. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, | ||
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||
102-860, 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; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; | ||
103-551, eff. 8-11-23; revised 8-29-23.) | ||
Section 25. The Illinois Insurance Code is amended by | ||
adding Section 356u.10 as follows: | ||
(215 ILCS 5/356u.10 new) | ||
Sec. 356u.10. Genetic testing and evidence-based | ||
screenings for an inherited gene mutation. | ||
(a) In this Section, "genetic testing for an inherited | ||
mutation" means germline multi-gene testing for an inherited | ||
mutation associated with an increased risk of cancer in | ||
accordance with evidence-based, clinical practice guidelines. | ||
(b) A group policy of accident and health insurance or | ||
managed care plan that is amended, delivered, issued, or | ||
renewed after January 1, 2026 shall provide coverage for | ||
clinical genetic testing for an inherited gene mutation for | ||
individuals with a personal or family history of cancer, as | ||
recommended by a health care professional in accordance with | ||
current evidence-based clinical practice guidelines, | ||
including, but not limited to, the current version of the | ||
National Comprehensive Cancer Network clinical practice | ||
guidelines. The coverage shall limit the total amount that a | ||
covered person is required to pay for a clinical genetic test | ||
under this subsection to an amount not to exceed $50, except | ||
for services for which cost sharing is prohibited under 42 | ||
U.S.C. 300gg-13. This subsection (b) shall not apply to | ||
coverage of genetic testing to the extent such coverage would | ||
disqualify a high-deductible health plan from eligibility for | ||
a health savings account pursuant to Section 223 of the | ||
Internal Revenue Code. | ||
(c) For individuals with a genetic test that is positive | ||
for an inherited mutation associated with an increased risk of | ||
cancer, coverage required under this Section shall include any | ||
evidence-based screenings, as recommended by a health care | ||
professional in accordance with current evidence-based | ||
clinical practice guidelines, to the extent that the | ||
management recommendation is not already covered by the | ||
policy, except that coverage for evidence-based screenings | ||
under this subsection (c) may be subject to a deductible, | ||
coinsurance, or other cost-sharing limitation so long as the | ||
limitation is not greater than that required for other related | ||
cancer risk management benefits covered under the policy. In | ||
this subsection, "evidence-based cancer screenings" means | ||
medically recommended evidence-based screening modalities in | ||
accordance with current clinical practice guidelines. | ||
Section 30. The Health Maintenance Organization Act is | ||
amended by changing Section 5-3 as follows: | ||
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | ||
Sec. 5-3. Insurance Code provisions. | ||
(a) Health Maintenance Organizations shall be subject to | ||
the provisions of Sections 133, 134, 136, 137, 139, 140, | ||
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | ||
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | ||
355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356u.10, | ||
356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, | ||
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||
356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, | ||
356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, | ||
356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, | ||
356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, | ||
356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, | ||
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, | ||
356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, | ||
356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, | ||
368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, | ||
408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of | ||
subsection (2) of Section 367, and Articles IIA, VIII 1/2, | ||
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | ||
Illinois Insurance Code. | ||
(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": | ||
(1) a corporation authorized under the Dental Service | ||
Plan Act or the Voluntary Health Services Plans Act; | ||
(2) a corporation organized under the laws of this | ||
State; or | ||
(3) a corporation organized under the laws of another | ||
state, 30% or more of the enrollees of which are residents | ||
of this State, except a corporation subject to | ||
substantially the same requirements in its state of | ||
organization as is a "domestic company" under Article VIII | ||
1/2 of the Illinois Insurance Code. | ||
(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; | ||
(3) the Director shall have the power to require the | ||
following information: | ||
(A) certification by an independent actuary of the | ||
adequacy of the reserves of the Health Maintenance | ||
Organization sought to be acquired; | ||
(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; | ||
(C) a pro forma business plan detailing an | ||
acquiring party's plans with respect to the operation | ||
of the Health Maintenance Organization sought to be | ||
acquired for a period of not less than 3 years; and | ||
(D) such other information as the Director shall | ||
require. | ||
(d) The provisions of Article VIII 1/2 of the Illinois | ||
Insurance Code and this Section 5-3 shall apply to the sale by | ||
any health maintenance organization of greater than 10% of its | ||
enrollee population (including, without limitation, the health | ||
maintenance organization's right, title, and interest in and | ||
to its health care certificates). | ||
(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. | ||
(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: | ||
(i) the amount of, and other terms and conditions with | ||
respect to, the refund or additional premium are set forth | ||
in the group or enrollment unit contract agreed in advance | ||
of the period for which a refund is to be paid or | ||
additional premium is to be charged (which period shall | ||
not be less than one year); 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)). The Health Maintenance Organization and | ||
the group or enrollment unit may agree that the profitable | ||
or unprofitable experience may be calculated taking into | ||
account the refund period and the immediately preceding 2 | ||
plan years. | ||
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. | ||
(g) Rulemaking authority to implement Public Act 95-1045, | ||
if any, is conditioned on the rules being adopted in | ||
accordance with all provisions of the Illinois Administrative | ||
Procedure Act and all rules and procedures of the Joint | ||
Committee on Administrative Rules; any purported rule not so | ||
adopted, for whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | ||
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | ||
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | ||
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | ||
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | ||
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | ||
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | ||
eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.) | ||
Section 35. The Voluntary Health Services Plans Act is | ||
amended by changing Section 10 as follows: | ||
(215 ILCS 165/10) (from Ch. 32, par. 604) | ||
Sec. 10. Application of Insurance Code provisions. 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, 136, 139, 140, | ||
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | ||
356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356u.10, 356v, | ||
356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, | ||
356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||
356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, | ||
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, | ||
356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, | ||
356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, | ||
356z.64, 356z.67, 356z.68, 364.01, 364.3, 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. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | ||
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. | ||
10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, | ||
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||
102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 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; 103-445, eff. 1-1-24; | ||
103-551, eff. 8-11-23; revised 8-29-23.) | ||
Section 40. The Illinois Public Aid Code is amended by | ||
adding Section 5-52 as follows: | ||
(305 ILCS 5/5-52 new) | ||
Sec. 5-52. Genetic testing and evidence-based screenings | ||
for an inherited gene mutation. | ||
(a) In this Section, "genetic testing for an inherited | ||
mutation" means germline multi-gene testing for an inherited | ||
mutation associated with an increased risk of cancer in | ||
accordance with evidence-based, clinical practice guidelines. | ||
(b) Subject to federal approval, the medical assistance | ||
program, after January 1, 2026, shall provide coverage for | ||
clinical genetic testing for an inherited gene mutation for | ||
individuals with a personal or family history of cancer, as | ||
recommended by a health care professional in accordance with | ||
current evidence-based clinical practice guidelines, | ||
including, but not limited to, the current version of the | ||
National Comprehensive Cancer Network clinical practice | ||
guidelines. | ||
(c) For individuals with a genetic test that is positive | ||
for an inherited mutation associated with an increased risk of | ||
cancer, coverage required under this Section shall include any | ||
evidence-based screenings, as recommended by a health care | ||
professional in accordance with current evidence-based | ||
clinical practice guidelines, to the extent that the | ||
management recommendation is not already covered by the | ||
medical assistance program. In this subsection, | ||
"evidence-based cancer screenings" means medically recommended | ||
evidence-based screening modalities in accordance with current | ||
clinical practice guidelines. | ||
Section 99. Effective date. This Section and Section 40 | ||
take effect January 1, 2025. | ||