Public Act 095-0189
 		





HB0147 Enrolled
LRB095 03747 DRJ 23776 b






    AN ACT concerning regulation.

 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:


 
    Section 1. 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.5,

356u, 356w, 356x, 356z.2, 356z.4, and 356z.6 of the
Illinois 
Insurance Code.
The program of health benefits must comply with 
Section 155.37 of the
Illinois Insurance Code.

(Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03; 
93-102, eff. 1-1-04; 93-853, eff. 1-1-05.)

 
    Section 2. The Department of Public Health Powers and 
Duties Law of the
Civil Administrative Code of Illinois is 
amended  by changing Section 2310-345 as follows:
 



    (20 ILCS 2310/2310-345)  (was 20 ILCS 2310/55.49)



    Sec. 2310-345. Breast cancer; written summary regarding 
early detection and
treatment.
    (a) From funds made available for this purpose, the

Department shall publish, in layman's language, a
standardized 
written summary outlining methods for the early detection and

diagnosis of breast cancer.  The summary shall include 
recommended
guidelines for screening and detection of breast 
cancer through the use of
techniques that shall include but not 
be limited to self-examination, clinical breast exams, and

diagnostic radiology.

    (b) The summary shall also suggest that women seek 
mammography
services from facilities that
are certified to 
perform mammography as required by the
federal Mammography 
Quality Standards Act of 1992.

    (c) The summary shall also include the medically viable

alternative
methods for the treatment of breast cancer, 
including, but not limited to,
hormonal, radiological, 
chemotherapeutic, or surgical treatments or
combinations 
thereof.  The summary shall contain information on breast

reconstructive surgery, including, but not limited to, the use 
of breast
implants and their side effects.
The summary shall 
inform the
patient of the advantages, disadvantages, risks, and 
dangers of the various
procedures.
The summary shall include 
(i) a statement that mammography is the most
accurate method 
for making an early detection of breast cancer, however, no

diagnostic tool is 100% effective, (ii) the benefits of 
clinical breast exams, and (iii)
and (ii) instructions for

instructions for performing breast self-examination and a 
statement that
it is
important to perform a breast 
self-examination monthly.

    (c-5) The summary shall specifically address the benefits

of early detection and review the clinical standard 
recommendations by the Centers for Disease Control and 
Prevention and the American Cancer Society for mammography, 
clinical breast exams, and breast self-exams.

    (c-10) The summary shall also inform individuals that 
public and private insurance providers shall pay for clinical 
breast exams as part of an exam, as indicated by guidelines of 
practice.

    (d) In developing the summary, the Department shall consult 
with the
Advisory Board of Cancer Control, the Illinois State 
Medical Society and
consumer groups.  The summary shall be 
updated by the Department every 2 years.

    (e) The summaries shall additionally be translated into 
Spanish, and
the Department shall conduct a public information 
campaign to distribute
the summaries to the Hispanic women of 
this State in order to inform them
of the importance of early 
detection and mammograms.

    (f) The Department shall distribute the summary to 
hospitals, public
health centers, and physicians who are likely 
to perform or order
diagnostic
tests for breast disease or 
treat breast cancer by surgical or other
medical methods.  Those 
hospitals, public health centers, and physicians
shall make the 
summaries available to the public.  The Department shall
also 
distribute the summaries to any person, organization, or other

interested parties upon request.  The summaries may be 
duplicated by any
person, provided the copies are identical to 
the current summary
prepared
by the Department.

    (g) The summary shall display, on the inside of its cover, 
printed in
capital letters, in bold face type, the following 
paragraph:

    "The information contained in this brochure regarding 
recommendations for
early detection and diagnosis of breast 
disease and alternative breast
disease treatments is only for 
the purpose of assisting you, the patient,
in understanding the 
medical information and advice offered by your
physician.  This 
brochure cannot serve as a substitute for the sound

professional advice of your physician.  The availability of this 
brochure
or the information contained within is not intended to 
alter, in any way,
the existing physician-patient 
relationship, nor the existing professional
obligations of 
your physician in the delivery of medical services to you,
the 
patient."

    (h) The summary shall be updated when necessary.

(Source: P.A. 91-239, eff. 1-1-00; revised 10-19-05.)

 
    Section 3. 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.5, 356u,
356w, 356x and 356z.6  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.  A home
rule county to which this Section applies 
must comply with every provision of
this Section.


(Source: P.A. 93-853, eff. 1-1-05.)

 
    Section 3.5. 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.5, 356u, 356w, 
356x and 356z.6 of the Illinois
Insurance
Code.  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.


(Source: P.A. 93-853, eff. 1-1-05.)

 
    Section 4. 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.5, 356u, 356w, 356x 
and 356z.6 of
the
Illinois Insurance Code.


(Source: P.A. 93-853, eff. 1-1-05.)

 
    Section 5. The Illinois Insurance Code is amended  by adding 
Section 356g.5 as follows:
 
    (215 ILCS 5/356g.5  new)
    Sec. 356g.5. Clinical breast exam.
    (a) The General Assembly finds that clinical breast 
examinations are a critical tool in the early detection of 
breast cancer, while the disease is in its earlier and 
potentially more treatable stages. Insurer reimbursement of 
clinical breast examinations is essential to the effort to 
reduce breast cancer deaths in Illinois.
    (b) Every insurer shall provide, in each group or 
individual policy, contract, or certificate of accident or 
health insurance issued or renewed for persons who are 
residents of Illinois, coverage for complete and thorough 
clinical breast examinations as indicated by guidelines of 
practice, performed by a physician licensed to practice 
medicine in all its branches, an advanced practice nurse who 
has a collaborative agreement with a collaborating physician 
that authorizes breast
examinations, or a physician assistant 
who has been delegated authority to provide breast 
examinations, to check for lumps and other changes for the 
purpose of early detection and prevention of breast cancer as 
follows:
        (1) at least every 3 years for women at least 20 years 
    of age but less than 40 years of age; and
        (2) annually for women 40 years of age or older.
    (c) Upon approval of a nationally recognized separate and 
distinct clinical breast exam code that is compliant with all 
State and federal laws, rules, and regulations, public and 
private insurance plans shall take action to cover clinical 
breast exams on a separate and distinct basis.
 
    Section 10. The Health Maintenance Organization Act is 
amended  by changing Section 4-6.5 as follows:
 



    (215 ILCS 125/4-6.5)



    Sec. 4-6.5. Required health benefits; Illinois Insurance 
Code
requirements.  A health maintenance organization is 
subject to the provisions
of Sections 155.37, 356g.5, 356t, 
356u, and 356z.1 of the Illinois Insurance Code.

(Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01; 
92-651, eff.
7-11-02.)

 
    Section 15. 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, 140, 143, 143c, 
149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, 
356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 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.

(Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01; 
92-651, eff. 7-11-02; 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; 
93-529, eff. 8-14-03; 93-853, eff. 1-1-05; 93-1000, eff. 
1-1-05; revised 10-14-04.)

 
    Section 20. The Illinois Public Aid Code is amended  by 
changing Section 5-16.8 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, 356u, 356w, 356x, and 356z.6 of the 
Illinois
Insurance Code and (ii) be subject to the provisions 
of Section 364.01 of the Illinois
Insurance Code.

(Source: P.A. 93-853, eff. 1-1-05; 93-1000, eff. 1-1-05; 
revised 10-14-04.)

 

    Section 99. Effective date. This Act takes effect upon 
becoming law.