Bill Text: IL HB0439 | 2009-2010 | 96th General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. In the Section concerning post-mastectomy care, requires insurance companies to provide coverage for (1) a minimum of 24 hours of inpatient care following a lymph node dissection for the treatment of breast cancer or (2) a minimum of 48 hours of inpatient care following a mastectomy or breast conserving surgery for the treatment of breast cancer. Prohibits insurance companies from giving incentives or penalties to physicians or providers. Provides that insurance companies must provide notice of the required coverage to each participant and beneficiary. Makes other changes.

Spectrum: Partisan Bill (Democrat 8-0)

Status: (Introduced - Dead) 2009-03-13 - Rule 19(a) / Re-referred to Rules Committee [HB0439 Detail]

Download: Illinois-2009-HB0439-Introduced.html

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96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 HB0439 Introduced 2/4/2009, by Rep. Fred Crespo SYNOPSIS AS INTRODUCED:
215 ILCS 5/356t
Amends the Illinois Insurance Code. In the Section concerning post-mastectomy care, requires insurance companies to provide coverage for (1) a minimum of 24 hours of inpatient care following a lymph node dissection for the treatment of breast cancer or (2) a minimum of 48 hours of inpatient care following a mastectomy or breast conserving surgery for the treatment of breast cancer. Prohibits insurance companies from giving incentives or penalties to physicians or providers. Provides that insurance companies must provide notice of the required coverage to each participant and beneficiary. Makes other changes.
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A BILL FOR
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AN ACT concerning insurance.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356t as follows:
(215 ILCS 5/356t)
Sec. 356t. Post-mastectomy care.
(a) An individual or group policy of accident and health
insurance or managed care plan that provides surgical coverage
and is amended, delivered, issued, or renewed after the
effective date of this amendatory Act of 1997 shall provide
inpatient coverage for medically necessary treatment following
a mastectomy. The policy or plan shall provide coverage for the
following:
(1) a minimum of 24 hours of inpatient care following a
lymph node dissection for the treatment of breast cancer,
except as otherwise provided in this Section; or
(2) a minimum of 48 hours of inpatient care following a
mastectomy or breast conserving surgery (such as a
lumpectomy) for the treatment of breast cancer, except as
otherwise provided in this Section.
A shorter length of hospital inpatient stay for services
related to a mastectomy, lumpectomy, or a lymph node dissection

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may be provided if the attending physician determines, in
consultation with the patient for a length of time determined
by the attending physician to be medically necessary and in
accordance with protocols and guidelines based on sound
scientific evidence and upon evaluation of the patient and the
coverage for and availability of a post-discharge physician
office visit or in-home nurse visit to verify the condition of
the patient in the first 48 hours after discharge, that a
shorter period of hospital stay is medically appropriate.
(b) An issuer of individual or group policy of accident and
health insurance or managed care plan that provides coverage
under this Section may not:
(1) require that a physician or provider obtain
authorization from the issuer or policy or plan for
prescribing any length of stay required under subsection
(a) of this Section;
(2) penalize or otherwise reduce or limit the
reimbursement of a physician or provider because the
physician or provider provided care to a patient in
accordance with subsection (a) of this Section;
(3) provide financial or other incentives to a
physician or provider in order to induce the physician or
provider to keep the length of inpatient stays of patients
following a mastectomy, lumpectomy, or a lymph node
dissection for the treatment of breast cancer below any
limits;

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(4) provide financial or other incentives to a
physician or provider in order to induce the physician or
provider to refrain from referring a patient for a
secondary consultation that would otherwise be covered by
the policy or plan; or
(5) deny to a participant eligibility or continued
eligibility to enroll or renew coverage under the terms of
the policy or plan or deny coverage solely for the purpose
of avoiding the requirements of this Section.
(c) An issuer of a policy or plan under this Section must
provide notice to each participant and beneficiary of the
coverage required by this Section. The notice shall be in
writing and prominently positioned in any literature or
correspondence made available or distributed by the issuer or
policy or plan.
(Source: P.A. 90-7, eff. 6-10-97; 90-655, eff. 7-30-98.)