Illinois 2023-2024 Regular Session

Illinois House Bill HB2078 Compare Versions

Only one version of the bill is available at this time.

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2078 Introduced , by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED: 215 ILCS 5/356g from Ch. 73, par. 968g Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches). LRB103 25679 BMS 52028 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2078 Introduced , by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED: 215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 5/356g from Ch. 73, par. 968g Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches). LRB103 25679 BMS 52028 b LRB103 25679 BMS 52028 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2078 Introduced , by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED:
3	3	215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 5/356g from Ch. 73, par. 968g
4	4	215 ILCS 5/356g from Ch. 73, par. 968g
5	5	Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches).
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8	8	A BILL FOR
9	9	HB2078LRB103 25679 BMS 52028 b HB2078 LRB103 25679 BMS 52028 b
10	10	HB2078 LRB103 25679 BMS 52028 b
11	11	1 AN ACT concerning regulation.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Insurance Code is amended by
15	15	5 changing Section 356g as follows:
16	16	6 (215 ILCS 5/356g) (from Ch. 73, par. 968g)
17	17	7 Sec. 356g. Mammograms; mastectomies.
18	18	8 (a) Every insurer shall provide in each group or
19	19	9 individual policy, contract, or certificate of insurance
20	20	10 issued or renewed for persons who are residents of this State,
21	21	11 coverage for screening by low-dose mammography for all women
22	22	12 35 years of age or older for the presence of occult breast
23	23	13 cancer within the provisions of the policy, contract, or
24	24	14 certificate. The coverage shall be as follows:
25	25	15 (1) A baseline mammogram for women 35 to 39 years of
26	26	16 age.
27	27	17 (2) An annual mammogram for women 40 years of age or
28	28	18 older.
29	29	19 (3) A mammogram at the age and intervals considered
30	30	20 medically necessary by the woman's health care provider
31	31	21 for women under 40 years of age and having a family history
32	32	22 of breast cancer, prior personal history of breast cancer,
33	33	23 positive genetic testing, or other risk factors.
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2078 Introduced , by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED:
38	38	215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 5/356g from Ch. 73, par. 968g
39	39	215 ILCS 5/356g from Ch. 73, par. 968g
40	40	Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches).
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43	43	A BILL FOR
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49	49	215 ILCS 5/356g from Ch. 73, par. 968g
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68	68	1 (4) For an individual or group policy of accident and
69	69	2 health insurance or a managed care plan that is amended,
70	70	3 delivered, issued, or renewed on or after the effective
71	71	4 date of this amendatory Act of the 101st General Assembly,
72	72	5 a comprehensive ultrasound screening and MRI of an entire
73	73	6 breast or breasts if a mammogram demonstrates
74	74	7 heterogeneous or dense breast tissue or when medically
75	75	8 necessary as determined by a physician licensed to
76	76	9 practice medicine in all of its branches.
77	77	10 (5) A screening MRI or ultrasound when medically
78	78	11 necessary, as determined by a physician licensed to
79	79	12 practice medicine in all of its branches.
80	80	13 (6) For an individual or group policy of accident and
81	81	14 health insurance or a managed care plan that is amended,
82	82	15 delivered, issued, or renewed on or after the effective
83	83	16 date of this amendatory Act of the 101st General Assembly,
84	84	17 a diagnostic mammogram when medically necessary, as
85	85	18 determined by a physician licensed to practice medicine in
86	86	19 all its branches, advanced practice registered nurse, or
87	87	20 physician assistant.
88	88	21 A policy subject to this subsection shall not impose a
89	89	22 deductible, coinsurance, copayment, or any other cost-sharing
90	90	23 requirement on the coverage provided; except that this
91	91	24 sentence does not apply to coverage of diagnostic mammograms
92	92	25 to the extent such coverage would disqualify a high-deductible
93	93	26 health plan from eligibility for a health savings account
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104	104	1 pursuant to Section 223 of the Internal Revenue Code (26
105	105	2 U.S.C. 223).
106	106	3 For purposes of this Section:
107	107	4 "Diagnostic mammogram" means a mammogram obtained using
108	108	5 diagnostic mammography.
109	109	6 "Diagnostic mammography" means a method of screening that
110	110	7 is designed to evaluate an abnormality in a breast, including
111	111	8 an abnormality seen or suspected on a screening mammogram or a
112	112	9 subjective or objective abnormality otherwise detected in the
113	113	10 breast.
114	114	11 "Low-dose mammography" means the x-ray examination of the
115	115	12 breast using equipment dedicated specifically for mammography,
116	116	13 including the x-ray tube, filter, compression device, and
117	117	14 image receptor, with radiation exposure delivery of less than
118	118	15 1 rad per breast for 2 views of an average size breast. The
119	119	16 term also includes digital mammography and includes breast
120	120	17 tomosynthesis. As used in this Section, the term "breast
121	121	18 tomosynthesis" means a radiologic procedure that involves the
122	122	19 acquisition of projection images over the stationary breast to
123	123	20 produce cross-sectional digital three-dimensional images of
124	124	21 the breast.
125	125	22 If, at any time, the Secretary of the United States
126	126	23 Department of Health and Human Services, or its successor
127	127	24 agency, promulgates rules or regulations to be published in
128	128	25 the Federal Register or publishes a comment in the Federal
129	129	26 Register or issues an opinion, guidance, or other action that
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140	140	1 would require the State, pursuant to any provision of the
141	141	2 Patient Protection and Affordable Care Act (Public Law
142	142	3 111-148), including, but not limited to, 42 U.S.C.
143	143	4 18031(d)(3)(B) or any successor provision, to defray the cost
144	144	5 of any coverage for breast tomosynthesis outlined in this
145	145	6 subsection, then the requirement that an insurer cover breast
146	146	7 tomosynthesis is inoperative other than any such coverage
147	147	8 authorized under Section 1902 of the Social Security Act, 42
148	148	9 U.S.C. 1396a, and the State shall not assume any obligation
149	149	10 for the cost of coverage for breast tomosynthesis set forth in
150	150	11 this subsection.
151	151	12 (a-5) Coverage as described by subsection (a) shall be
152	152	13 provided at no cost to the insured and shall not be applied to
153	153	14 an annual or lifetime maximum benefit.
154	154	15 (a-10) When health care services are available through
155	155	16 contracted providers and a person does not comply with plan
156	156	17 provisions specific to the use of contracted providers, the
157	157	18 requirements of subsection (a-5) are not applicable. When a
158	158	19 person does not comply with plan provisions specific to the
159	159	20 use of contracted providers, plan provisions specific to the
160	160	21 use of non-contracted providers must be applied without
161	161	22 distinction for coverage required by this Section and shall be
162	162	23 at least as favorable as for other radiological examinations
163	163	24 covered by the policy or contract.
164	164	25 (b) No policy of accident or health insurance that
165	165	26 provides for the surgical procedure known as a mastectomy
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176	176	1 shall be issued, amended, delivered, or renewed in this State
177	177	2 unless that coverage also provides for prosthetic devices or
178	178	3 reconstructive surgery incident to the mastectomy. Coverage
179	179	4 for breast reconstruction in connection with a mastectomy
180	180	5 shall include:
181	181	6 (1) reconstruction of the breast upon which the
182	182	7 mastectomy has been performed;
183	183	8 (2) surgery and reconstruction of the other breast to
184	184	9 produce a symmetrical appearance; and
185	185	10 (3) prostheses and treatment for physical
186	186	11 complications at all stages of mastectomy, including
187	187	12 lymphedemas.
188	188	13 Care shall be determined in consultation with the attending
189	189	14 physician and the patient. The offered coverage for prosthetic
190	190	15 devices and reconstructive surgery shall be subject to the
191	191	16 deductible and coinsurance conditions applied to the
192	192	17 mastectomy, and all other terms and conditions applicable to
193	193	18 other benefits. When a mastectomy is performed and there is no
194	194	19 evidence of malignancy then the offered coverage may be
195	195	20 limited to the provision of prosthetic devices and
196	196	21 reconstructive surgery to within 2 years after the date of the
197	197	22 mastectomy. As used in this Section, "mastectomy" means the
198	198	23 removal of all or part of the breast for medically necessary
199	199	24 reasons, as determined by a licensed physician.
200	200	25 Written notice of the availability of coverage under this
201	201	26 Section shall be delivered to the insured upon enrollment and
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212	212	1 annually thereafter. An insurer may not deny to an insured
213	213	2 eligibility, or continued eligibility, to enroll or to renew
214	214	3 coverage under the terms of the plan solely for the purpose of
215	215	4 avoiding the requirements of this Section. An insurer may not
216	216	5 penalize or reduce or limit the reimbursement of an attending
217	217	6 provider or provide incentives (monetary or otherwise) to an
218	218	7 attending provider to induce the provider to provide care to
219	219	8 an insured in a manner inconsistent with this Section.
220	220	9 (c) Rulemaking authority to implement Public Act 95-1045,
221	221	10 if any, is conditioned on the rules being adopted in
222	222	11 accordance with all provisions of the Illinois Administrative
223	223	12 Procedure Act and all rules and procedures of the Joint
224	224	13 Committee on Administrative Rules; any purported rule not so
225	225	14 adopted, for whatever reason, is unauthorized.
226	226	15 (Source: P.A. 100-395, eff. 1-1-18; 101-580, eff. 1-1-20.)
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