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91_SB1424
LRB9111947JSpc
1 AN ACT to create the Mandated Benefits Review Act.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the
5 Mandated Benefits Review Act.
6 Section 5. Purpose. The purpose of this Act is to
7 provide for independent review of mandated benefits. This Act
8 requires that all existing mandated health benefits,
9 proposals or an amendment to a proposal for mandated
10 benefits, mandated health insurance coverage, and mandated
11 offerings of health benefits be referred to the Director of
12 Insurance to commission an independent actuarial review of
13 the mandated benefit with regard to the proposals' social
14 impact, medical efficacy, and financial impact.
15 Section 10. Mandated benefit review.
16 (a) "Mandated benefits" means:
17 (1) any mandated coverage for specific services,
18 treatments, medications, or practices;
19 (2) any mandated direct reimbursement to specific
20 health care providers;
21 (3) any mandated offering for specific services,
22 treatments, medications, or practices;
23 (4) any mandated reimbursement amount to specific
24 health care providers.
25 (b) Within 7 days after a bill or an amendment to a bill
26 containing a mandated benefit as defined in subsection (a)
27 has been assigned to a committee in either house of the
28 General Assembly, the chairman of the committee may refer the
29 bill or amendment to the bill to the Director of Insurance
30 for a mandated benefits review.
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1 (c) No bill shall be reported by a committee with a
2 recommendation for passage, and no vote shall be taken by a
3 committee on any proposed amendment or substitute bill, until
4 after the committee members have received a mandated benefits
5 report and recommendation from the Director of Insurance.
6 (d) Within 10 days after receipt of the bill or
7 amendment to a bill containing a mandated benefit, the
8 Director of Insurance shall commission an independent
9 actuarial review of the mandated benefit with regard to the
10 proposal's social impact, medical efficacy, and financial
11 impact.
12 (e) Within 30 days after receipt of the bill or
13 amendment to a bill containing a mandated benefit, the
14 Director of Insurance shall report the independent actuarial
15 review's findings and the Director's recommendation in
16 writing to the chairman of the committee, the committee
17 members, and members of the General Assembly.
18 (f) In performing an actuarial review of a mandated
19 benefit, the actuary shall apply the following guidelines:
20 (1) the actuary shall consider evidence of social
21 impact, including to what extent is the treatment or
22 service:
23 (A) needed by the citizens of the State of
24 Illinois;
25 (B) available to the citizens of the State of
26 Illinois;
27 (C) utilized by the population of the State of
28 Illinois;
29 (2) if insurance is not generally in place, the
30 actuary shall determine to what extent the lack of
31 coverage results in inadequate health care or major
32 financial hardship;
33 (3) the actuary shall determine the demand for the
34 proposed health care coverage from the public at large
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1 and in collective bargaining negotiations;
2 (4) if the legislation seeks to mandate coverage of
3 a specific therapy, the actuary shall consider the
4 medical efficacy of the benefit as follows:
5 (A) the results of at least one professionally
6 acceptable, controlled trial demonstrating the
7 medical consequences of that therapy compared to no
8 therapy or to alternative therapies;
9 (B) the results of any other relevant
10 research;
11 (5) the actuary shall review the following evidence
12 of financial impact:
13 (A) the extent to which the coverage will
14 increase or decrease the cost of treatment or
15 service;
16 (B) the extent to which similar mandates have
17 affected charges, costs, and payments experienced in
18 other states with such mandates;
19 (C) the extent to which the coverage will
20 increase the appropriate use of treatment or
21 service;
22 (D) the extent to which the mandated treatment
23 or service will be a substitute for more expansive
24 or less expansive treatment of service;
25 (E) the extent to which the coverage will
26 increase or decrease the administrative expenses of
27 insurance companies and the premium and
28 administrative expenses of policyholders;
29 (F) the extent to which existing mandates meet
30 the requirements of this Act;
31 (G) the financial impact of this coverage on
32 small employers, medium-sized employers, and large
33 employers; and
34 (H) the impact of this coverage on the total
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1 cost of health care.
2 Section 20. Review of existing mandated benefits. In
3 addition to the duties prescribed by this Act with respect to
4 legislation, the Director of Insurance shall commission a
5 separate and complete review of all existing State-mandated
6 benefits, mandated health insurance coverage, and mandated
7 offerings of health benefits in the same manner as prescribed
8 in Sections 10 and 15 of this Act. The Director of Insurance
9 shall report the findings of existing State-mandated
10 benefits, mandated health insurance coverage, and mandated
11 offerings of health benefits to the General Assembly no
12 latter than January 1, 2001.
13 Section 99. Effective date. This Act takes effect upon
14 becoming law.