Bill Text: IL HB5295 | 2023-2024 | 103rd General Assembly | Chaptered
Bill Title: Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary hormonal and non-hormonal therapy to treat menopausal symptoms if the therapy is recommended by a qualified health care provider who is licensed, accredited, or certified under Illinois law and the therapy has been proven safe and effective in peer-reviewed scientific studies. Provides that coverage for therapy to treat menopausal symptoms shall include all federal Food and Drug Administration-approved modalities of hormonal and non-hormonal administration, including, but not limited to, oral, transdermal, topical, and vaginal rings. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the medical assistance program shall provide coverage for medically necessary hormone therapy treatment to treat menopause that has been induced by a hysterectomy. Makes a conforming change. Effective January 1, 2026.
Spectrum: Partisan Bill (Democrat 31-1)
Status: (Passed) 2024-07-19 - Public Act . . . . . . . . . 103-0703 [HB5295 Detail]
Download: Illinois-2023-HB5295-Chaptered.html
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| Public Act 103-0703 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois, | ||||
represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by | ||||
changing Section 356z.56 as follows:
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(215 ILCS 5/356z.56) | ||||
Sec. 356z.56. Coverage for hormonal and non-hormonal | ||||
hormone therapy to treat menopause. A group or individual | ||||
policy of accident and health insurance or a managed care plan | ||||
that is amended, delivered, issued, or renewed in this State | ||||
on or after January 1, 2024 shall provide coverage for | ||||
medically necessary hormone therapy treatment to treat | ||||
menopause that has been induced by a hysterectomy. This | ||||
coverage applies only to coverage provided on or after January | ||||
1, 2024 and before January 1, 2026. | ||||
A group or individual policy of accident and health | ||||
insurance or a managed care plan that is amended, delivered, | ||||
issued, or renewed on or after January 1, 2026 shall provide | ||||
coverage for medically necessary hormonal and non-hormonal | ||||
therapy to treat menopausal symptoms if the therapy is | ||||
recommended by a qualified health care provider who is | ||||
licensed, accredited, or certified under Illinois law and the | ||||
therapy has been proven safe and effective in peer-reviewed | ||||
scientific studies. Coverage for therapy to treat menopausal | ||
symptoms shall include all federal Food and Drug | ||
Administration-approved modalities of hormonal and | ||
non-hormonal administration, including, but not limited to, | ||
oral, transdermal, topical, and vaginal rings. | ||
(Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23.)
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Section 10. The Illinois Public Aid Code is amended by | ||
changing Section 5-16.8 and by adding Section 5-52 as follows:
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(305 ILCS 5/5-16.8) | ||
Sec. 5-16.8. Required health benefits. The medical | ||
assistance program shall (i) provide the post-mastectomy care | ||
benefits required to be covered by a policy of accident and | ||
health insurance under Section 356t and the coverage required | ||
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, | ||
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | ||
356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and | ||
356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code, | ||
(ii) be subject to the provisions of Sections 356z.19, | ||
356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois | ||
Insurance Code, and (iii) be subject to the provisions of | ||
subsection (d-5) of Section 10 of the Network Adequacy and | ||
Transparency Act. | ||
The Department, by rule, shall adopt a model similar to | ||
the requirements of Section 356z.39 of the Illinois Insurance | ||
Code. | ||
On and after July 1, 2012, the Department shall reduce any | ||
rate of reimbursement for services or other payments or alter | ||
any methodologies authorized by this Code to reduce any rate | ||
of reimbursement for services or other payments in accordance | ||
with Section 5-5e. | ||
To ensure full access to the benefits set forth in this | ||
Section, on and after January 1, 2016, the Department shall | ||
ensure that provider and hospital reimbursement for | ||
post-mastectomy care benefits required under this Section are | ||
no lower than the Medicare reimbursement rate. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. | ||
1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, | ||
eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | ||
1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
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(305 ILCS 5/5-52 new) | ||
Sec. 5-52. Coverage for hormonal therapy to treat | ||
menopause. The medical assistance program shall provide | ||
coverage for medically necessary hormone therapy treatment to | ||
treat menopause that has been induced by a hysterectomy.
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