Public Act 102-0034

SB1096 Enrolled LRB102 04919 CPF 14938 b

AN ACT concerning regulation.

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

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

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

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

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

(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

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

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

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

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.