Bill Amendment: IL HB3673 | 2015-2016 | 99th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: INS CD-PUB AID CD-MRI COVERAGE

Status: 2015-08-21 - Public Act . . . . . . . . . 99-0433 [HB3673 Detail]

Download: Illinois-2015-HB3673-House_Amendment_001.html

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Rep. Mike Smiddy

Filed: 3/23/2015

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AMENDMENT TO HOUSE BILL 3673
AMENDMENT NO. ______. Amend House Bill 3673 as follows:
on page 2, by replacing line 17 with the following:
"mammography and shall include breast tomosynthesis. As used in
this Section, the term "breast tomosynthesis" means a
radiologic procedure that involves the acquisition of
projection images over the stationary breast to produce
cross-sectional digital three-dimensional images of the
breast."; and
on page 4, immediately below line 23, by inserting the
following:
"Section 10. The Health Maintenance Organization Act is
amended by changing Section 4-6.1 as follows:
(215 ILCS 125/4-6.1) (from Ch. 111 1/2, par. 1408.7)

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Sec. 4-6.1. Mammograms; mastectomies.
(a) Every contract or evidence of coverage issued by a
Health Maintenance Organization for persons who are residents
of this State shall contain coverage for screening by low-dose
mammography for all women 35 years of age or older for the
presence of occult breast cancer. The coverage shall be as
follows:
(1) A baseline mammogram for women 35 to 39 years of
age.
(2) An annual mammogram for women 40 years of age or
older.
(3) A mammogram at the age and intervals considered
medically necessary by the woman's health care provider for
women under 40 years of age and having a family history of
breast cancer, prior personal history of breast cancer,
positive genetic testing, or other risk factors.
(4) A comprehensive ultrasound screening of an entire
breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue, when medically
necessary as determined by a physician licensed to practice
medicine in all of its branches.
For purposes of this Section, "low-dose mammography" means
the x-ray examination of the breast using equipment dedicated
specifically for mammography, including the x-ray tube,
filter, compression device, and image receptor, with radiation
exposure delivery of less than 1 rad per breast for 2 views of

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an average size breast. The term also includes digital
mammography and shall include breast tomosynthesis. As used in
this Section, the term "breast tomosynthesis" means a
radiologic procedure that involves the acquisition of
projection images over the stationary breast to produce
cross-sectional digital three-dimensional images of the
breast.
(a-5) Coverage as described in subsection (a) shall be
provided at no cost to the enrollee and shall not be applied to
an annual or lifetime maximum benefit.
(b) No contract or evidence of coverage issued by a health
maintenance organization that provides for the surgical
procedure known as a mastectomy shall be issued, amended,
delivered, or renewed in this State on or after the effective
date of this amendatory Act of the 92nd General Assembly unless
that coverage also provides for prosthetic devices or
reconstructive surgery incident to the mastectomy, providing
that the mastectomy is performed after the effective date of
this amendatory Act. Coverage for breast reconstruction in
connection with a mastectomy shall include:
(1) reconstruction of the breast upon which the
mastectomy has been performed;
(2) surgery and reconstruction of the other breast to
produce a symmetrical appearance; and
(3) prostheses and treatment for physical
complications at all stages of mastectomy, including

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lymphedemas.
Care shall be determined in consultation with the attending
physician and the patient. The offered coverage for prosthetic
devices and reconstructive surgery shall be subject to the
deductible and coinsurance conditions applied to the
mastectomy and all other terms and conditions applicable to
other benefits. When a mastectomy is performed and there is no
evidence of malignancy, then the offered coverage may be
limited to the provision of prosthetic devices and
reconstructive surgery to within 2 years after the date of the
mastectomy. As used in this Section, "mastectomy" means the
removal of all or part of the breast for medically necessary
reasons, as determined by a licensed physician.
Written notice of the availability of coverage under this
Section shall be delivered to the enrollee upon enrollment and
annually thereafter. A health maintenance organization may not
deny to an enrollee eligibility, or continued eligibility, to
enroll or to renew coverage under the terms of the plan solely
for the purpose of avoiding the requirements of this Section. A
health maintenance organization may not penalize or reduce or
limit the reimbursement of an attending provider or provide
incentives (monetary or otherwise) to an attending provider to
induce the provider to provide care to an insured in a manner
inconsistent with this Section.
(c) Rulemaking authority to implement this amendatory Act
of the 95th General Assembly, if any, is conditioned on the

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rules being adopted in accordance with all provisions of the
Illinois Administrative Procedure Act and all rules and
procedures of the Joint Committee on Administrative Rules; any
purported rule not so adopted, for whatever reason, is
unauthorized.
(Source: P.A. 94-121, eff. 7-6-05; 95-431, eff. 8-24-07;
95-1045, eff. 3-27-09.)"; and
on page 4, line 24, by replacing "Section 10." with "Section
15."; and
on page 11, by replacing line 5 with the following:
"includes digital mammography and shall include breast
tomosynthesis. As used in this Section, the term "breast
tomosynthesis" means a radiologic procedure that involves the
acquisition of projection images over the stationary breast to
produce cross-sectional digital three-dimensional images of
the breast.".