Illinois 2023-2024 Regular Session

Illinois Senate Bill SB3225 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 SB3225 Introduced 2/6/2024, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.26a new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 165/10 from Ch. 32, par. 604 Amends the Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2025 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions. LRB103 38466 RPS 68602 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3225 Introduced 2/6/2024, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.26a new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 165/10 from Ch. 32, par. 604 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.26a new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 165/10 from Ch. 32, par. 604 Amends the Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2025 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions. LRB103 38466 RPS 68602 b LRB103 38466 RPS 68602 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3225 Introduced 2/6/2024, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED:
3	3	5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.26a new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 165/10 from Ch. 32, par. 604 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.26a new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 165/10 from Ch. 32, par. 604
4	4	5 ILCS 375/6.11
5	5	55 ILCS 5/5-1069.3
6	6	65 ILCS 5/10-4-2.3
7	7	105 ILCS 5/10-22.3f
8	8	215 ILCS 5/356z.26a new
9	9	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
10	10	215 ILCS 165/10 from Ch. 32, par. 604
11	11	Amends the Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2025 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions.
12	12	LRB103 38466 RPS 68602 b LRB103 38466 RPS 68602 b
13	13	LRB103 38466 RPS 68602 b
14	14	A BILL FOR
15	15	SB3225LRB103 38466 RPS 68602 b SB3225 LRB103 38466 RPS 68602 b
16	16	SB3225 LRB103 38466 RPS 68602 b
17	17	1 AN ACT concerning regulation.
18	18	2 Be it enacted by the People of the State of Illinois,
19	19	3 represented in the General Assembly:
20	20	4 Section 5. The State Employees Group Insurance Act of 1971
21	21	5 is amended by changing Section 6.11 as follows:
22	22	6 (5 ILCS 375/6.11)
23	23	7 Sec. 6.11. Required health benefits; Illinois Insurance
24	24	8 Code requirements. The program of health benefits shall
25	25	9 provide the post-mastectomy care benefits required to be
26	26	10 covered by a policy of accident and health insurance under
27	27	11 Section 356t of the Illinois Insurance Code. The program of
28	28	12 health benefits shall provide the coverage required under
29	29	13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
30	30	14 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
31	31	15 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
32	32	16 356z.25, 356z.26, 356z.26a, 356z.29, 356z.30a, 356z.32,
33	33	17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
34	34	18 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
35	35	19 356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
36	36	20 and 356z.70 of the Illinois Insurance Code. The program of
37	37	21 health benefits must comply with Sections 155.22a, 155.37,
38	38	22 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
39	39	23 Illinois Insurance Code. The program of health benefits shall
40	40
41	41
42	42
43	43	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3225 Introduced 2/6/2024, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED:
44	44	5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.26a new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 165/10 from Ch. 32, par. 604 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.26a new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 165/10 from Ch. 32, par. 604
45	45	5 ILCS 375/6.11
46	46	55 ILCS 5/5-1069.3
47	47	65 ILCS 5/10-4-2.3
48	48	105 ILCS 5/10-22.3f
49	49	215 ILCS 5/356z.26a new
50	50	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
51	51	215 ILCS 165/10 from Ch. 32, par. 604
52	52	Amends the Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2025 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions.
53	53	LRB103 38466 RPS 68602 b LRB103 38466 RPS 68602 b
54	54	LRB103 38466 RPS 68602 b
55	55	A BILL FOR
56	56
57	57
58	58
59	59
60	60
61	61	5 ILCS 375/6.11
62	62	55 ILCS 5/5-1069.3
63	63	65 ILCS 5/10-4-2.3
64	64	105 ILCS 5/10-22.3f
65	65	215 ILCS 5/356z.26a new
66	66	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
67	67	215 ILCS 165/10 from Ch. 32, par. 604
68	68
69	69
70	70
71	71	LRB103 38466 RPS 68602 b
72	72
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85	85	SB3225 - 2 - LRB103 38466 RPS 68602 b
86	86	1 provide the coverage required under Section 356m of the
87	87	2 Illinois Insurance Code and, for the employees of the State
88	88	3 Employee Group Insurance Program only, the coverage as also
89	89	4 provided in Section 6.11B of this Act. The Department of
90	90	5 Insurance shall enforce the requirements of this Section with
91	91	6 respect to Sections 370c and 370c.1 of the Illinois Insurance
92	92	7 Code; all other requirements of this Section shall be enforced
93	93	8 by the Department of Central Management Services.
94	94	9 Rulemaking authority to implement Public Act 95-1045, if
95	95	10 any, is conditioned on the rules being adopted in accordance
96	96	11 with all provisions of the Illinois Administrative Procedure
97	97	12 Act and all rules and procedures of the Joint Committee on
98	98	13 Administrative Rules; any purported rule not so adopted, for
99	99	14 whatever reason, is unauthorized.
100	100	15 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
101	101	16 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
102	102	17 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
103	103	18 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
104	104	19 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
105	105	20 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
106	106	21 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
107	107	22 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
108	108	23 8-11-23; revised 8-29-23.)
109	109	24 Section 10. The Counties Code is amended by changing
110	110	25 Section 5-1069.3 as follows:
111	111
112	112
113	113
114	114
115	115
116	116	SB3225 - 2 - LRB103 38466 RPS 68602 b
117	117
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119	119	SB3225- 3 -LRB103 38466 RPS 68602 b SB3225 - 3 - LRB103 38466 RPS 68602 b
120	120	SB3225 - 3 - LRB103 38466 RPS 68602 b
121	121	1 (55 ILCS 5/5-1069.3)
122	122	2 Sec. 5-1069.3. Required health benefits. If a county,
123	123	3 including a home rule county, is a self-insurer for purposes
124	124	4 of providing health insurance coverage for its employees, the
125	125	5 coverage shall include coverage for the post-mastectomy care
126	126	6 benefits required to be covered by a policy of accident and
127	127	7 health insurance under Section 356t and the coverage required
128	128	8 under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
129	129	9 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
130	130	10 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
131	131	11 356z.26a, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
132	132	12 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
133	133	13 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
134	134	14 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
135	135	15 of the Illinois Insurance Code. The coverage shall comply with
136	136	16 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
137	137	17 Insurance Code. The Department of Insurance shall enforce the
138	138	18 requirements of this Section. The requirement that health
139	139	19 benefits be covered as provided in this Section is an
140	140	20 exclusive power and function of the State and is a denial and
141	141	21 limitation under Article VII, Section 6, subsection (h) of the
142	142	22 Illinois Constitution. A home rule county to which this
143	143	23 Section applies must comply with every provision of this
144	144	24 Section.
145	145	25 Rulemaking authority to implement Public Act 95-1045, if
146	146
147	147
148	148
149	149
150	150
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152	152
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154	154	SB3225- 4 -LRB103 38466 RPS 68602 b SB3225 - 4 - LRB103 38466 RPS 68602 b
155	155	SB3225 - 4 - LRB103 38466 RPS 68602 b
156	156	1 any, is conditioned on the rules being adopted in accordance
157	157	2 with all provisions of the Illinois Administrative Procedure
158	158	3 Act and all rules and procedures of the Joint Committee on
159	159	4 Administrative Rules; any purported rule not so adopted, for
160	160	5 whatever reason, is unauthorized.
161	161	6 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
162	162	7 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
163	163	8 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
164	164	9 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
165	165	10 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
166	166	11 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
167	167	12 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
168	168	13 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
169	169	14 8-29-23.)
170	170	15 Section 15. The Illinois Municipal Code is amended by
171	171	16 changing Section 10-4-2.3 as follows:
172	172	17 (65 ILCS 5/10-4-2.3)
173	173	18 Sec. 10-4-2.3. Required health benefits. If a
174	174	19 municipality, including a home rule municipality, is a
175	175	20 self-insurer for purposes of providing health insurance
176	176	21 coverage for its employees, the coverage shall include
177	177	22 coverage for the post-mastectomy care benefits required to be
178	178	23 covered by a policy of accident and health insurance under
179	179	24 Section 356t and the coverage required under Sections 356g,
180	180
181	181
182	182
183	183
184	184
185	185	SB3225 - 4 - LRB103 38466 RPS 68602 b
186	186
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188	188	SB3225- 5 -LRB103 38466 RPS 68602 b SB3225 - 5 - LRB103 38466 RPS 68602 b
189	189	SB3225 - 5 - LRB103 38466 RPS 68602 b
190	190	1 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
191	191	2 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
192	192	3 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.26a,
193	193	4 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
194	194	5 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
195	195	6 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and
196	196	7 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70 of the
197	197	8 Illinois Insurance Code. The coverage shall comply with
198	198	9 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
199	199	10 Insurance Code. The Department of Insurance shall enforce the
200	200	11 requirements of this Section. The requirement that health
201	201	12 benefits be covered as provided in this is an exclusive power
202	202	13 and function of the State and is a denial and limitation under
203	203	14 Article VII, Section 6, subsection (h) of the Illinois
204	204	15 Constitution. A home rule municipality to which this Section
205	205	16 applies must comply with every provision of this Section.
206	206	17 Rulemaking authority to implement Public Act 95-1045, if
207	207	18 any, is conditioned on the rules being adopted in accordance
208	208	19 with all provisions of the Illinois Administrative Procedure
209	209	20 Act and all rules and procedures of the Joint Committee on
210	210	21 Administrative Rules; any purported rule not so adopted, for
211	211	22 whatever reason, is unauthorized.
212	212	23 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
213	213	24 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
214	214	25 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
215	215	26 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
216	216
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224	224	SB3225- 6 -LRB103 38466 RPS 68602 b SB3225 - 6 - LRB103 38466 RPS 68602 b
225	225	SB3225 - 6 - LRB103 38466 RPS 68602 b
226	226	1 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
227	227	2 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
228	228	3 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
229	229	4 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
230	230	5 8-29-23.)
231	231	6 Section 20. The School Code is amended by changing Section
232	232	7 10-22.3f as follows:
233	233	8 (105 ILCS 5/10-22.3f)
234	234	9 Sec. 10-22.3f. Required health benefits. Insurance
235	235	10 protection and benefits for employees shall provide the
236	236	11 post-mastectomy care benefits required to be covered by a
237	237	12 policy of accident and health insurance under Section 356t and
238	238	13 the coverage required under Sections 356g, 356g.5, 356g.5-1,
239	239	14 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
240	240	15 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
241	241	16 356z.25, 356z.26, 356z.26a 356z.29, 356z.30a, 356z.32,
242	242	17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
243	243	18 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
244	244	19 and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
245	245	20 356z.70 of the Illinois Insurance Code. Insurance policies
246	246	21 shall comply with Section 356z.19 of the Illinois Insurance
247	247	22 Code. The coverage shall comply with Sections 155.22a, 355b,
248	248	23 and 370c of the Illinois Insurance Code. The Department of
249	249	24 Insurance shall enforce the requirements of this Section.
250	250
251	251
252	252
253	253
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259	259	SB3225 - 7 - LRB103 38466 RPS 68602 b
260	260	1 Rulemaking authority to implement Public Act 95-1045, if
261	261	2 any, is conditioned on the rules being adopted in accordance
262	262	3 with all provisions of the Illinois Administrative Procedure
263	263	4 Act and all rules and procedures of the Joint Committee on
264	264	5 Administrative Rules; any purported rule not so adopted, for
265	265	6 whatever reason, is unauthorized.
266	266	7 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
267	267	8 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
268	268	9 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
269	269	10 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
270	270	11 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
271	271	12 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
272	272	13 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
273	273	14 103-551, eff. 8-11-23; revised 8-29-23.)
274	274	15 Section 25. The Illinois Insurance Code is amended by
275	275	16 adding Section 356z.26a as follows:
276	276	17 (215 ILCS 5/356z.26a new)
277	277	18 Sec. 356z.26a. Clinician-administered drugs.
278	278	19 (a) As used in this Section:
279	279	20 "Clinician-administered drug" means an outpatient
280	280	21 prescription drug other than a vaccine that:
281	281	22 (1) cannot reasonably be self-administered by the
282	282	23 patient to whom the drug is prescribed or by an individual
283	283	24 assisting the patient with the self-administration; and
284	284
285	285
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293	293	SB3225 - 8 - LRB103 38466 RPS 68602 b
294	294	1 (2) is typically administered:
295	295	2 (A) by a health care provider authorized under the
296	296	3 laws of this State to administer the drug, including a
297	297	4 health care provider acting under a physician's
298	298	5 delegation and supervision; and
299	299	6 (B) in a physician's office, hospital outpatient
300	300	7 infusion center, or other clinical setting.
301	301	8 "Health benefit plan" means an individual or group policy
302	302	9 of accident or health insurance, health care plan, or other
303	303	10 hospital or medical policy, certificate, or contract.
304	304	11 "Health care plan" has the meaning given to that term in
305	305	12 Section 1-2 of the Health Maintenance Organization Act.
306	306	13 "Health care plan" does not include a managed care
307	307	14 organization that provides, arranges, or reimburses for the
308	308	15 delivery of health care services to individuals who are
309	309	16 enrolled in the program of medical assistance under the
310	310	17 Illinois Public Aid Code or under the Children's Health
311	311	18 Insurance Program Act.
312	312	19 "Pharmacy" has the meaning given to that term in Section 3
313	313	20 of the Pharmacy Practice Act.
314	314	21 "Provider" has the meaning given to that term in Section
315	315	22 370g.
316	316	23 "Site of service" means the physical location where a
317	317	24 clinician-administered drug is administered, including, but
318	318	25 not limited to, an outpatient hospital, physician's office,
319	319	26 ambulatory infusion site, home-based site, or other clinical
320	320
321	321
322	322
323	323
324	324
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330	330	1 setting.
331	331	2 (b) To ensure access to safe and effective drug therapies,
332	332	3 a health benefit plan amended, delivered, issued, or renewed
333	333	4 on or after January 1, 2025 that provides prescription drug
334	334	5 coverage through a medical or pharmacy health benefit or its
335	335	6 contracted pharmacy benefit manager shall not:
336	336	7 (1) require an enrollee to obtain a covered
337	337	8 clinician-administered drug from a pharmacy selected by
338	338	9 the health benefit plan or pharmacy benefit manager with
339	339	10 the intent to transport the drug to another site of
340	340	11 service for administration;
341	341	12 (2) require an enrollee to obtain a covered
342	342	13 clinician-administered drug from a pharmacy selected by
343	343	14 the health benefit plan or pharmacy benefit manager;
344	344	15 (3) notwithstanding any other provision of law, steer
345	345	16 or offer financial or other incentives to induce an
346	346	17 enrollee to obtain a clinician-administered drug from a
347	347	18 pharmacy identified by the health benefit plan or pharmacy
348	348	19 benefit manager;
349	349	20 (4) condition, deny, restrict, refuse to authorize, or
350	350	21 otherwise limit benefits and coverage to an enrollee for
351	351	22 medically necessary clinician-administered drugs and
352	352	23 related services obtained from the provider that
353	353	24 administers the drug or from a pharmacy that is not
354	354	25 selected by the health benefit plan or pharmacy benefit
355	355	26 manager;
356	356
357	357
358	358
359	359
360	360
361	361	SB3225 - 9 - LRB103 38466 RPS 68602 b
362	362
363	363
364	364	SB3225- 10 -LRB103 38466 RPS 68602 b SB3225 - 10 - LRB103 38466 RPS 68602 b
365	365	SB3225 - 10 - LRB103 38466 RPS 68602 b
366	366	1 (5) condition, deny, restrict, refuse to authorize, or
367	367	2 otherwise limit reimbursement to a provider for covered
368	368	3 medically necessary clinician-administered drugs and
369	369	4 related services obtained from the provider that
370	370	5 administers the drug or from a pharmacy that is not
371	371	6 selected by the health benefit plan or pharmacy benefit
372	372	7 manager;
373	373	8 (6) assess higher deductibles, copayments,
374	374	9 coinsurance, or other cost-sharing amounts for
375	375	10 clinician-administered drugs obtained from the provider
376	376	11 that administers the drug or from a pharmacy that is not
377	377	12 selected by the health benefit plan or pharmacy benefit
378	378	13 manager;
379	379	14 (7) require an enrollee to use a home infusion
380	380	15 pharmacy to receive clinician-administered drugs in the
381	381	16 enrollee's home or to use a site of service identified by
382	382	17 the health benefit plan or pharmacy benefit manager;
383	383	18 (8) include the site of service in prior approval or
384	384	19 medical necessity criteria for clinician-administered
385	385	20 drugs;
386	386	21 (9) require an enrollee to use the pharmacy benefit
387	387	22 for specific clinician-administered drugs; or
388	388	23 (10) prohibit a provider from billing the health
389	389	24 benefit plan for reimbursement of clinician-administered
390	390	25 drugs.
391	391	26 (c) A clinician-administered drug shall meet the supply
392	392
393	393
394	394
395	395
396	396
397	397	SB3225 - 10 - LRB103 38466 RPS 68602 b
398	398
399	399
400	400	SB3225- 11 -LRB103 38466 RPS 68602 b SB3225 - 11 - LRB103 38466 RPS 68602 b
401	401	SB3225 - 11 - LRB103 38466 RPS 68602 b
402	402	1 chain security controls and chain of distribution set by the
403	403	2 federal Drug Supply Chain Security Act.
404	404	3 (d) The Department may adopt rules as necessary to
405	405	4 implement the provisions of this Section.
406	406	5 Section 30. The Health Maintenance Organization Act is
407	407	6 amended by changing Section 5-3 as follows:
408	408	7 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
409	409	8 Sec. 5-3. Insurance Code provisions.
410	410	9 (a) Health Maintenance Organizations shall be subject to
411	411	10 the provisions of Sections 133, 134, 136, 137, 139, 140,
412	412	11 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
413	413	12 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
414	414	13 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
415	415	14 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
416	416	15 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
417	417	16 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
418	418	17 356z.23, 356z.24, 356z.25, 356z.26, 356z.26a, 356z.28,
419	419	18 356z.29, 356z.30, 356z.30a, 356z.31, 356z.32, 356z.33,
420	420	19 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
421	421	20 356z.41, 356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49,
422	422	21 356z.50, 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57,
423	423	22 356z.58, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65,
424	424	23 356z.67, 356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
425	425	24 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
426	426
427	427
428	428
429	429
430	430
431	431	SB3225 - 11 - LRB103 38466 RPS 68602 b
432	432
433	433
434	434	SB3225- 12 -LRB103 38466 RPS 68602 b SB3225 - 12 - LRB103 38466 RPS 68602 b
435	435	SB3225 - 12 - LRB103 38466 RPS 68602 b
436	436	1 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
437	437	2 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
438	438	3 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
439	439	4 Illinois Insurance Code.
440	440	5 (b) For purposes of the Illinois Insurance Code, except
441	441	6 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
442	442	7 Health Maintenance Organizations in the following categories
443	443	8 are deemed to be "domestic companies":
444	444	9 (1) a corporation authorized under the Dental Service
445	445	10 Plan Act or the Voluntary Health Services Plans Act;
446	446	11 (2) a corporation organized under the laws of this
447	447	12 State; or
448	448	13 (3) a corporation organized under the laws of another
449	449	14 state, 30% or more of the enrollees of which are residents
450	450	15 of this State, except a corporation subject to
451	451	16 substantially the same requirements in its state of
452	452	17 organization as is a "domestic company" under Article VIII
453	453	18 1/2 of the Illinois Insurance Code.
454	454	19 (c) In considering the merger, consolidation, or other
455	455	20 acquisition of control of a Health Maintenance Organization
456	456	21 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
457	457	22 (1) the Director shall give primary consideration to
458	458	23 the continuation of benefits to enrollees and the
459	459	24 financial conditions of the acquired Health Maintenance
460	460	25 Organization after the merger, consolidation, or other
461	461	26 acquisition of control takes effect;
462	462
463	463
464	464
465	465
466	466
467	467	SB3225 - 12 - LRB103 38466 RPS 68602 b
468	468
469	469
470	470	SB3225- 13 -LRB103 38466 RPS 68602 b SB3225 - 13 - LRB103 38466 RPS 68602 b
471	471	SB3225 - 13 - LRB103 38466 RPS 68602 b
472	472	1 (2)(i) the criteria specified in subsection (1)(b) of
473	473	2 Section 131.8 of the Illinois Insurance Code shall not
474	474	3 apply and (ii) the Director, in making his determination
475	475	4 with respect to the merger, consolidation, or other
476	476	5 acquisition of control, need not take into account the
477	477	6 effect on competition of the merger, consolidation, or
478	478	7 other acquisition of control;
479	479	8 (3) the Director shall have the power to require the
480	480	9 following information:
481	481	10 (A) certification by an independent actuary of the
482	482	11 adequacy of the reserves of the Health Maintenance
483	483	12 Organization sought to be acquired;
484	484	13 (B) pro forma financial statements reflecting the
485	485	14 combined balance sheets of the acquiring company and
486	486	15 the Health Maintenance Organization sought to be
487	487	16 acquired as of the end of the preceding year and as of
488	488	17 a date 90 days prior to the acquisition, as well as pro
489	489	18 forma financial statements reflecting projected
490	490	19 combined operation for a period of 2 years;
491	491	20 (C) a pro forma business plan detailing an
492	492	21 acquiring party's plans with respect to the operation
493	493	22 of the Health Maintenance Organization sought to be
494	494	23 acquired for a period of not less than 3 years; and
495	495	24 (D) such other information as the Director shall
496	496	25 require.
497	497	26 (d) The provisions of Article VIII 1/2 of the Illinois
498	498
499	499
500	500
501	501
502	502
503	503	SB3225 - 13 - LRB103 38466 RPS 68602 b
504	504
505	505
506	506	SB3225- 14 -LRB103 38466 RPS 68602 b SB3225 - 14 - LRB103 38466 RPS 68602 b
507	507	SB3225 - 14 - LRB103 38466 RPS 68602 b
508	508	1 Insurance Code and this Section 5-3 shall apply to the sale by
509	509	2 any health maintenance organization of greater than 10% of its
510	510	3 enrollee population (including, without limitation, the health
511	511	4 maintenance organization's right, title, and interest in and
512	512	5 to its health care certificates).
513	513	6 (e) In considering any management contract or service
514	514	7 agreement subject to Section 141.1 of the Illinois Insurance
515	515	8 Code, the Director (i) shall, in addition to the criteria
516	516	9 specified in Section 141.2 of the Illinois Insurance Code,
517	517	10 take into account the effect of the management contract or
518	518	11 service agreement on the continuation of benefits to enrollees
519	519	12 and the financial condition of the health maintenance
520	520	13 organization to be managed or serviced, and (ii) need not take
521	521	14 into account the effect of the management contract or service
522	522	15 agreement on competition.
523	523	16 (f) Except for small employer groups as defined in the
524	524	17 Small Employer Rating, Renewability and Portability Health
525	525	18 Insurance Act and except for medicare supplement policies as
526	526	19 defined in Section 363 of the Illinois Insurance Code, a
527	527	20 Health Maintenance Organization may by contract agree with a
528	528	21 group or other enrollment unit to effect refunds or charge
529	529	22 additional premiums under the following terms and conditions:
530	530	23 (i) the amount of, and other terms and conditions with
531	531	24 respect to, the refund or additional premium are set forth
532	532	25 in the group or enrollment unit contract agreed in advance
533	533	26 of the period for which a refund is to be paid or
534	534
535	535
536	536
537	537
538	538
539	539	SB3225 - 14 - LRB103 38466 RPS 68602 b
540	540
541	541
542	542	SB3225- 15 -LRB103 38466 RPS 68602 b SB3225 - 15 - LRB103 38466 RPS 68602 b
543	543	SB3225 - 15 - LRB103 38466 RPS 68602 b
544	544	1 additional premium is to be charged (which period shall
545	545	2 not be less than one year); and
546	546	3 (ii) the amount of the refund or additional premium
547	547	4 shall not exceed 20% of the Health Maintenance
548	548	5 Organization's profitable or unprofitable experience with
549	549	6 respect to the group or other enrollment unit for the
550	550	7 period (and, for purposes of a refund or additional
551	551	8 premium, the profitable or unprofitable experience shall
552	552	9 be calculated taking into account a pro rata share of the
553	553	10 Health Maintenance Organization's administrative and
554	554	11 marketing expenses, but shall not include any refund to be
555	555	12 made or additional premium to be paid pursuant to this
556	556	13 subsection (f)). The Health Maintenance Organization and
557	557	14 the group or enrollment unit may agree that the profitable
558	558	15 or unprofitable experience may be calculated taking into
559	559	16 account the refund period and the immediately preceding 2
560	560	17 plan years.
561	561	18 The Health Maintenance Organization shall include a
562	562	19 statement in the evidence of coverage issued to each enrollee
563	563	20 describing the possibility of a refund or additional premium,
564	564	21 and upon request of any group or enrollment unit, provide to
565	565	22 the group or enrollment unit a description of the method used
566	566	23 to calculate (1) the Health Maintenance Organization's
567	567	24 profitable experience with respect to the group or enrollment
568	568	25 unit and the resulting refund to the group or enrollment unit
569	569	26 or (2) the Health Maintenance Organization's unprofitable
570	570
571	571
572	572
573	573
574	574
575	575	SB3225 - 15 - LRB103 38466 RPS 68602 b
576	576
577	577
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579	579	SB3225 - 16 - LRB103 38466 RPS 68602 b
580	580	1 experience with respect to the group or enrollment unit and
581	581	2 the resulting additional premium to be paid by the group or
582	582	3 enrollment unit.
583	583	4 In no event shall the Illinois Health Maintenance
584	584	5 Organization Guaranty Association be liable to pay any
585	585	6 contractual obligation of an insolvent organization to pay any
586	586	7 refund authorized under this Section.
587	587	8 (g) Rulemaking authority to implement Public Act 95-1045,
588	588	9 if any, is conditioned on the rules being adopted in
589	589	10 accordance with all provisions of the Illinois Administrative
590	590	11 Procedure Act and all rules and procedures of the Joint
591	591	12 Committee on Administrative Rules; any purported rule not so
592	592	13 adopted, for whatever reason, is unauthorized.
593	593	14 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
594	594	15 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
595	595	16 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
596	596	17 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
597	597	18 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
598	598	19 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
599	599	20 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
600	600	21 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
601	601	22 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
602	602	23 eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
603	603	24 Section 35. The Voluntary Health Services Plans Act is
604	604	25 amended by changing Section 10 as follows:
605	605
606	606
607	607
608	608
609	609
610	610	SB3225 - 16 - LRB103 38466 RPS 68602 b
611	611
612	612
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614	614	SB3225 - 17 - LRB103 38466 RPS 68602 b
615	615	1 (215 ILCS 165/10) (from Ch. 32, par. 604)
616	616	2 Sec. 10. Application of Insurance Code provisions. Health
617	617	3 services plan corporations and all persons interested therein
618	618	4 or dealing therewith shall be subject to the provisions of
619	619	5 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
620	620	6 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
621	621	7 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
622	622	8 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
623	623	9 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
624	624	10 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
625	625	11 356z.26, 356z.26a, 356z.29, 356z.30, 356z.30a, 356z.32,
626	626	12 356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
627	627	13 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
628	628	14 356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
629	629	15 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
630	630	16 and (15) of Section 367 of the Illinois Insurance Code.
631	631	17 Rulemaking authority to implement Public Act 95-1045, if
632	632	18 any, is conditioned on the rules being adopted in accordance
633	633	19 with all provisions of the Illinois Administrative Procedure
634	634	20 Act and all rules and procedures of the Joint Committee on
635	635	21 Administrative Rules; any purported rule not so adopted, for
636	636	22 whatever reason, is unauthorized.
637	637	23 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
638	638	24 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
639	639	25 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
640	640
641	641
642	642
643	643
644	644
645	645	SB3225 - 17 - LRB103 38466 RPS 68602 b
646	646
647	647
648	648	SB3225- 18 -LRB103 38466 RPS 68602 b SB3225 - 18 - LRB103 38466 RPS 68602 b
649	649	SB3225 - 18 - LRB103 38466 RPS 68602 b
650	650
651	651
652	652
653	653
654	654
655	655	SB3225 - 18 - LRB103 38466 RPS 68602 b