Bill Amendment: IL SB1096 | 2021-2022 | 102nd General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: INS CD-COVID-19 TESTING

Status: 2021-06-25 - Public Act . . . . . . . . . 102-0034 [SB1096 Detail]

Download: Illinois-2021-SB1096-Senate_Amendment_001.html

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Sen. Ann Gillespie

Filed: 4/21/2021

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AMENDMENT TO SENATE BILL 1096
AMENDMENT NO. ______. Amend Senate Bill 1096 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Insurance Code is amended by
adding Section 356z.43 as follows:
(215 ILCS 5/356z.43 new)
Sec. 356z.43. Coverage for COVID-19 diagnostic testing for
nursing home employees.
(a) As used in this Section:
"COVID-19" means the disease caused by SARS-CoV-2 or any
further mutation.
"Department" means the Department of Public Health.
"Diagnostic testing" means testing administered for the
purposes of diagnosing COVID-19 or a related virus and the
administration of such tests if the test is:
(1) approved, cleared, or authorized under Section

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510(k), 513, 515, or 564 of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 360(k), 360c, 360e, and 360bbb-3);
(2) the subject of a request or intended request for
emergency use authorization under Section 564 of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb-3)
until the emergency use authorization request has been
denied or the developer of the test does not submit a
request within a reasonable timeframe;
(3) developed and authorized by a state that has
notified the Secretary of the United States Department of
Health and Human Services of its intention to review a
test intended to diagnose COVID-19; or
(4) determined by the Secretary of the United States
Department of Health and Human Services or the Director of
the Centers for Disease Control and Prevention as
appropriate for the diagnosis of COVID-19.
"Enrollee" means a long-term care facility employee who is
covered by a health plan.
"Health plan" means (i) individual health insurance
coverage, as defined in Section 5 of the Illinois Health
Insurance Portability and Accountability Act, and (ii) group
health insurance coverage, as defined in Section 5 of the
Illinois Health Insurance Portability and Accountability Act
for employees of a licensed long-term care facility.
"Long-term care facility" means a long-term care facility
as defined in Section 1-113 of the Nursing Home Care Act, an

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assisted living establishment as defined in Section 10 of the
Assisted Living and Shared Housing Act, a MC/DD facility as
defined in Section 1-113 of the MC/DD Act, an ID/DD facility as
defined in Section 1-113 of the ID/DD Community Care Act, a
facility as defined in Section 1-102 of the Specialized Mental
Health Rehabilitation Act of 2013, or a supportive living
facility as defined in Section 5.01a of the Illinois Public
Aid Code.
"Testing provider" means a provider that is authorized by
the Department of Public Health to perform diagnostic testing
for licensed long-term care facilities.
(b) A health plan amended, delivered, issued, or renewed
on or after the effective date of this amendatory Act of the
102nd General Assembly shall provide coverage of diagnostic
testing for enrollees that is performed by a testing provider
in accordance with federal COVID-19 testing requirements as
set forth in subsection (h) of 42 CFR 483.80; emergency rules
adopted by the Department in 77 Ill. Adm. Code 295.4045,
300.696, 330.340, 350.760, and 390.340; and applicable federal
and Department guidance.
(c) Testing performed in accordance with subsection (b)
shall be considered medically necessary for the purposes of
this Section.
(d) A health plan may inquire as to whether an enrollee is
an employee of the long-term care facility but shall not
require further evidence or verification of the enrollee's

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employment status.
(e) The coverage requirements set forth in this Section
shall only apply when the testing requirements set forth in
subsection (b) are in effect.
(f) Any failure to provide coverage pursuant to this
Section shall be deemed a failure to substantially comply with
this Code.
(g) This Section is repealed on January 1, 2022.
Section 10. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection

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(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
Insurance Code.
(b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
(1) a corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act;
(2) a corporation organized under the laws of this
State; or
(3) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a "domestic company" under Article VIII
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
(1) the Director shall give primary consideration to
the continuation of benefits to enrollees and the
financial conditions of the acquired Health Maintenance
Organization after the merger, consolidation, or other
acquisition of control takes effect;
(2)(i) the criteria specified in subsection (1)(b) of

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Section 131.8 of the Illinois Insurance Code shall not
apply and (ii) the Director, in making his determination
with respect to the merger, consolidation, or other
acquisition of control, need not take into account the
effect on competition of the merger, consolidation, or
other acquisition of control;
(3) the Director shall have the power to require the
following information:
(A) certification by an independent actuary of the
adequacy of the reserves of the Health Maintenance
Organization sought to be acquired;
(B) pro forma financial statements reflecting the
combined balance sheets of the acquiring company and
the Health Maintenance Organization sought to be
acquired as of the end of the preceding year and as of
a date 90 days prior to the acquisition, as well as pro
forma financial statements reflecting projected
combined operation for a period of 2 years;
(C) a pro forma business plan detailing an
acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by

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any health maintenance organization of greater than 10% of its
enrollee population (including without limitation the health
maintenance organization's right, title, and interest in and
to its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
(f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall

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not be less than one year); and
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this
subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and

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the resulting additional premium to be paid by the group or
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
1-1-20; 101-625, eff. 1-1-21.)
(215 ILCS 195/Act rep.)
Section 15. The COVID-19 Medically Necessary Diagnostic
Testing Act is repealed.".