Illinois 2023-2024 Regular Session

Illinois House Bill HB4421 Compare Versions

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

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4421 Introduced , by Rep. Janet Yang Rohr SYNOPSIS AS INTRODUCED: 215 ILCS 5/356g from Ch. 73, par. 968g Amends the Illinois Insurance Code. In a provision concerning coverage for mammograms, provides that if a woman's physician has ordered the patient to receive breast tomosynthesis because it has been determined that high breast density will make low-dose mammography inaccurate or ineffective, the insurer shall not require the physician to order an additional low-dose mammography as a precondition to breast tomosynthesis, nor shall an insurer require the patient to receive a low-dose mammography as a precondition to breast tomosynthesis. Provides that if the results of a woman's first 2-dimensional mammogram screening determine that the patient has high breast density, coverage of breast tomosynthesis shall be provided at no cost to the insured, regardless of whether the breast tomosynthesis and 2-dimensional mammogram occurs within the same calendar year, coverage year, or 365-day period. LRB103 36181 RPS 66273 b STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4421 Introduced , by Rep. Janet Yang Rohr SYNOPSIS AS INTRODUCED: 215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 5/356g from Ch. 73, par. 968g Amends the Illinois Insurance Code. In a provision concerning coverage for mammograms, provides that if a woman's physician has ordered the patient to receive breast tomosynthesis because it has been determined that high breast density will make low-dose mammography inaccurate or ineffective, the insurer shall not require the physician to order an additional low-dose mammography as a precondition to breast tomosynthesis, nor shall an insurer require the patient to receive a low-dose mammography as a precondition to breast tomosynthesis. Provides that if the results of a woman's first 2-dimensional mammogram screening determine that the patient has high breast density, coverage of breast tomosynthesis shall be provided at no cost to the insured, regardless of whether the breast tomosynthesis and 2-dimensional mammogram occurs within the same calendar year, coverage year, or 365-day period. LRB103 36181 RPS 66273 b LRB103 36181 RPS 66273 b STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4421 Introduced , by Rep. Janet Yang Rohr 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 Illinois Insurance Code. In a provision concerning coverage for mammograms, provides that if a woman's physician has ordered the patient to receive breast tomosynthesis because it has been determined that high breast density will make low-dose mammography inaccurate or ineffective, the insurer shall not require the physician to order an additional low-dose mammography as a precondition to breast tomosynthesis, nor shall an insurer require the patient to receive a low-dose mammography as a precondition to breast tomosynthesis. Provides that if the results of a woman's first 2-dimensional mammogram screening determine that the patient has high breast density, coverage of breast tomosynthesis shall be provided at no cost to the insured, regardless of whether the breast tomosynthesis and 2-dimensional mammogram occurs within the same calendar year, coverage year, or 365-day period.
6	6	LRB103 36181 RPS 66273 b LRB103 36181 RPS 66273 b
7	7	LRB103 36181 RPS 66273 b
8	8	STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY
9	9	STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY
10	10	A BILL FOR
11	11	HB4421LRB103 36181 RPS 66273 b HB4421 LRB103 36181 RPS 66273 b
12	12	HB4421 LRB103 36181 RPS 66273 b
13	13	1 AN ACT concerning regulation.
14	14	2 Be it enacted by the People of the State of Illinois,
15	15	3 represented in the General Assembly:
16	16	4 Section 5. The Illinois Insurance Code is amended by
17	17	5 changing Section 356g as follows:
18	18	6 (215 ILCS 5/356g) (from Ch. 73, par. 968g)
19	19	7 Sec. 356g. Mammograms; mastectomies.
20	20	8 (a) Every insurer shall provide in each group or
21	21	9 individual policy, contract, or certificate of insurance
22	22	10 issued or renewed for persons who are residents of this State,
23	23	11 coverage for screening by low-dose mammography for all women
24	24	12 35 years of age or older for the presence of occult breast
25	25	13 cancer within the provisions of the policy, contract, or
26	26	14 certificate. The coverage shall be as follows:
27	27	15 (1) A baseline mammogram for women 35 to 39 years of
28	28	16 age.
29	29	17 (2) An annual mammogram for women 40 years of age or
30	30	18 older.
31	31	19 (3) A mammogram at the age and intervals considered
32	32	20 medically necessary by the woman's health care provider
33	33	21 for women under 40 years of age and having a family history
34	34	22 of breast cancer, prior personal history of breast cancer,
35	35	23 positive genetic testing, or other risk factors.
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39	39	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4421 Introduced , by Rep. Janet Yang Rohr SYNOPSIS AS INTRODUCED:
40	40	215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 5/356g from Ch. 73, par. 968g
41	41	215 ILCS 5/356g from Ch. 73, par. 968g
42	42	Amends the Illinois Insurance Code. In a provision concerning coverage for mammograms, provides that if a woman's physician has ordered the patient to receive breast tomosynthesis because it has been determined that high breast density will make low-dose mammography inaccurate or ineffective, the insurer shall not require the physician to order an additional low-dose mammography as a precondition to breast tomosynthesis, nor shall an insurer require the patient to receive a low-dose mammography as a precondition to breast tomosynthesis. Provides that if the results of a woman's first 2-dimensional mammogram screening determine that the patient has high breast density, coverage of breast tomosynthesis shall be provided at no cost to the insured, regardless of whether the breast tomosynthesis and 2-dimensional mammogram occurs within the same calendar year, coverage year, or 365-day period.
43	43	LRB103 36181 RPS 66273 b LRB103 36181 RPS 66273 b
44	44	LRB103 36181 RPS 66273 b
45	45	STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY
46	46	STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY
47	47	A BILL FOR
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53	53	215 ILCS 5/356g from Ch. 73, par. 968g
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57	57	LRB103 36181 RPS 66273 b
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59	59	STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY
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76	76	1 (4) For an individual or group policy of accident and
77	77	2 health insurance or a managed care plan that is amended,
78	78	3 delivered, issued, or renewed on or after the effective
79	79	4 date of this amendatory Act of the 101st General Assembly,
80	80	5 a comprehensive ultrasound screening and MRI of an entire
81	81	6 breast or breasts if a mammogram demonstrates
82	82	7 heterogeneous or dense breast tissue or when medically
83	83	8 necessary as determined by a physician licensed to
84	84	9 practice medicine in all of its branches.
85	85	10 (5) A screening MRI when medically necessary, as
86	86	11 determined by a physician licensed to practice medicine in
87	87	12 all of its branches.
88	88	13 (6) For an individual or group policy of accident and
89	89	14 health insurance or a managed care plan that is amended,
90	90	15 delivered, issued, or renewed on or after the effective
91	91	16 date of this amendatory Act of the 101st General Assembly,
92	92	17 a diagnostic mammogram when medically necessary, as
93	93	18 determined by a physician licensed to practice medicine in
94	94	19 all its branches, advanced practice registered nurse, or
95	95	20 physician assistant.
96	96	21 If a woman's physician has ordered the patient to receive
97	97	22 breast tomosynthesis because it has been determined that high
98	98	23 breast density will make low-dose mammography inaccurate or
99	99	24 ineffective, the insurer shall not require the physician to
100	100	25 order an additional low-dose mammography as a precondition to
101	101	26 breast tomosynthesis, nor shall an insurer require the patient
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112	112	1 to receive a low-dose mammography as a precondition to breast
113	113	2 tomosynthesis. This paragraph applies to an individual or
114	114	3 group policy of accident and health insurance or a managed
115	115	4 care plan that is amended, delivered, issued, or renewed on or
116	116	5 after the effective date of this amendatory Act of the 103rd
117	117	6 General Assembly.
118	118	7 If the results of a woman's first 2-dimensional mammogram
119	119	8 screening determine that the patient has high breast density,
120	120	9 coverage of breast tomosynthesis shall be provided at no cost
121	121	10 to the insured, regardless of whether the breast tomosynthesis
122	122	11 and 2-dimensional mammogram occurs within the same calendar
123	123	12 year, coverage year, or 365-day period. This paragraph applies
124	124	13 to an individual or group policy of accident and health
125	125	14 insurance or a managed care plan that is amended, delivered,
126	126	15 issued, or renewed on or after the effective date of this
127	127	16 amendatory Act of the 103rd General Assembly.
128	128	17 A policy subject to this subsection shall not impose a
129	129	18 deductible, coinsurance, copayment, or any other cost-sharing
130	130	19 requirement on the coverage provided; except that this
131	131	20 sentence does not apply to coverage of diagnostic mammograms
132	132	21 to the extent such coverage would disqualify a high-deductible
133	133	22 health plan from eligibility for a health savings account
134	134	23 pursuant to Section 223 of the Internal Revenue Code (26
135	135	24 U.S.C. 223).
136	136	25 For purposes of this Section:
137	137	26 "Diagnostic mammogram" means a mammogram obtained using
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148	148	1 diagnostic mammography.
149	149	2 "Diagnostic mammography" means a method of screening that
150	150	3 is designed to evaluate an abnormality in a breast, including
151	151	4 an abnormality seen or suspected on a screening mammogram or a
152	152	5 subjective or objective abnormality otherwise detected in the
153	153	6 breast.
154	154	7 "Low-dose mammography" means the x-ray examination of the
155	155	8 breast using equipment dedicated specifically for mammography,
156	156	9 including the x-ray tube, filter, compression device, and
157	157	10 image receptor, with radiation exposure delivery of less than
158	158	11 1 rad per breast for 2 views of an average size breast. The
159	159	12 term also includes digital mammography and includes breast
160	160	13 tomosynthesis. As used in this Section, the term "breast
161	161	14 tomosynthesis" means a radiologic procedure that involves the
162	162	15 acquisition of projection images over the stationary breast to
163	163	16 produce cross-sectional digital three-dimensional images of
164	164	17 the breast.
165	165	18 If, at any time, the Secretary of the United States
166	166	19 Department of Health and Human Services, or its successor
167	167	20 agency, promulgates rules or regulations to be published in
168	168	21 the Federal Register or publishes a comment in the Federal
169	169	22 Register or issues an opinion, guidance, or other action that
170	170	23 would require the State, pursuant to any provision of the
171	171	24 Patient Protection and Affordable Care Act (Public Law
172	172	25 111-148), including, but not limited to, 42 U.S.C.
173	173	26 18031(d)(3)(B) or any successor provision, to defray the cost
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184	184	1 of any coverage for breast tomosynthesis outlined in this
185	185	2 subsection, then the requirement that an insurer cover breast
186	186	3 tomosynthesis is inoperative other than any such coverage
187	187	4 authorized under Section 1902 of the Social Security Act, 42
188	188	5 U.S.C. 1396a, and the State shall not assume any obligation
189	189	6 for the cost of coverage for breast tomosynthesis set forth in
190	190	7 this subsection.
191	191	8 (a-5) Coverage as described by subsection (a) shall be
192	192	9 provided at no cost to the insured and shall not be applied to
193	193	10 an annual or lifetime maximum benefit.
194	194	11 (a-10) When health care services are available through
195	195	12 contracted providers and a person does not comply with plan
196	196	13 provisions specific to the use of contracted providers, the
197	197	14 requirements of subsection (a-5) are not applicable. When a
198	198	15 person does not comply with plan provisions specific to the
199	199	16 use of contracted providers, plan provisions specific to the
200	200	17 use of non-contracted providers must be applied without
201	201	18 distinction for coverage required by this Section and shall be
202	202	19 at least as favorable as for other radiological examinations
203	203	20 covered by the policy or contract.
204	204	21 (b) No policy of accident or health insurance that
205	205	22 provides for the surgical procedure known as a mastectomy
206	206	23 shall be issued, amended, delivered, or renewed in this State
207	207	24 unless that coverage also provides for prosthetic devices or
208	208	25 reconstructive surgery incident to the mastectomy. Coverage
209	209	26 for breast reconstruction in connection with a mastectomy
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220	220	1 shall include:
221	221	2 (1) reconstruction of the breast upon which the
222	222	3 mastectomy has been performed;
223	223	4 (2) surgery and reconstruction of the other breast to
224	224	5 produce a symmetrical appearance; and
225	225	6 (3) prostheses and treatment for physical
226	226	7 complications at all stages of mastectomy, including
227	227	8 lymphedemas.
228	228	9 Care shall be determined in consultation with the attending
229	229	10 physician and the patient. The offered coverage for prosthetic
230	230	11 devices and reconstructive surgery shall be subject to the
231	231	12 deductible and coinsurance conditions applied to the
232	232	13 mastectomy, and all other terms and conditions applicable to
233	233	14 other benefits. When a mastectomy is performed and there is no
234	234	15 evidence of malignancy then the offered coverage may be
235	235	16 limited to the provision of prosthetic devices and
236	236	17 reconstructive surgery to within 2 years after the date of the
237	237	18 mastectomy. As used in this Section, "mastectomy" means the
238	238	19 removal of all or part of the breast for medically necessary
239	239	20 reasons, as determined by a licensed physician.
240	240	21 Written notice of the availability of coverage under this
241	241	22 Section shall be delivered to the insured upon enrollment and
242	242	23 annually thereafter. An insurer may not deny to an insured
243	243	24 eligibility, or continued eligibility, to enroll or to renew
244	244	25 coverage under the terms of the plan solely for the purpose of
245	245	26 avoiding the requirements of this Section. An insurer may not
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