May 2008 Legistrative Update
May 15th, 2008
The situation at the Capitol has gone from bad to worse and Speaker Madigan finally stated publicly what all legislators and lobbyists have known for over a year when he stated that Democrats are engaged in a “civil war” and that “no prisoners are being taken” in the democratic family feud. While the Senate continues to bottle up House-passed measures, like a constitutional amendment providing a recall mechanism for constitutional officers and members of the General Assembly, Speaker Madigan and House Democrats have been busy moving legislation to the floor reenacting Illinois’ old Structural Work Act and a bill establishing a single payer universal coverage health insurance plan.
As the shots are fired back and forth across the rotunda, Governor Blagojevich remains mired in historically low ratings with one poll recently measuring his approval rating at an astonishing 13%. The Governor continues to suffer legal and political setbacks as the Tony Rezko trial unveils a massive “pay to play” fundraising scheme and a Cook County judge ordered the administration to stop enrollment in his unilateral move to expand the state’s Medicaid program, Family Care.
Although the 3rd reading deadline for bills in their original chamber has passed, both the House and Senate have extended the deadline for several weeks. The General Assembly has three weeks to conclude their business, and since there has been no progress on a Fiscal Year 2009 budget, it looks like legislators are in for a very long summer unless something major develops between now and then.
With the exception of HB 2094, the Construction Safety Act of 2008 (reenacting the old Structural Work Act that was repealed in 1995), almost all of the legislation activity this session has been focused on the life and health side of the insurance industry.
Health Insurance
Shortly after the Cook County judge issued his temporary restraining order stopping the Governor from expanding the FamilyCare program, State Representative Mary Flowers, Chair of the House Health Care Access and Availability Committee advanced HB 311, the Health Care for All Illinois Act, to the floor.
HB 311 would create a state run single payer health plan and would prohibit private insurers from selling plans that duplicate coverage of the program. While it stretches the imagination to take the legislation seriously when the state is billions in debt and can’t pay its current bills, it is significant that almost 30 House Democrats, including Speaker Madigan, have joined as cosponsors of the legislation.
Most in the health care industry believe that the House Democrats want something they can point to as an alternative to the Governor’s health care plans.
Meanwhile, several expensive health insurance mandates continue to advance out of both chambers.
HB 953 Lang (Jacobs) Amends the Illinois Insurance Code. Requires coverage of treatment for mental, emotional, or nervous disorders or conditions by a licensed marriage and family therapist when the insurance covers mental, emotional, or nervous disorders or conditions. Effective immediately.
Status: Passed House, Senate Referred to Rules
HB 1432 Crespo (Cullerton) - Amends the Illinois Insurance Code. Changes the definition of “serious mental illness” to include eating disorders, including anorexia nervosa, bulimia nervosa, and Eating Disorders Not Otherwise Specified (EDNOS), as recognized by the most current edition of the Diagnostic and Statistical Manual.
Status: Passed House, Senate Assigned to Insurance
HB 4223 Flowers (Collins) - Mandatory External Appeals - Provides that a policy of accident or health insurance or managed care plan shall establish and maintain an appeals procedure related to the denial of health care benefits. Sets forth guidelines for maintaining an appeals procedure, including an expedited process for an enrollee with an ongoing course of treatment ordered by a health care provider, the denial of which could significantly increase the risk to an enrollee’s health, or a treatment referral, service, procedure, or other health care service, the denial of which could significantly increase the risk to an enrollee’s health. Provides that if an initial appeal is denied by the policy or plan, an enrollee is entitled to seek external independent review of the decision made by the policy or plan. Sets forth guidelines and requirements for the external independent review process. Provides that the Office of Consumer Health Insurance of the Division of Insurance shall adopt rules for the enforcement of the provision.
Status: Passed House, Senate Referred to Rules
HB 4602 Beiser - Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to provide coverage for a federally approved shingles vaccine
Status: Passed House, Senate Assigned to Insurance
HB 4620 Smith - Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Voluntary Health Services Plans Act, and the Public Aid Code to provide coverage for heart disease prevention tests for women. Effective immediately
Status: House 2nd Reading
HB 4830 May (Garrett) – State Continuation Changes - Amends the Illinois Insurance Code and HMO Code. Provides that an employee or member or the eligible dependent of an employee or member is eligible for continuing coverage under a group insurance policy for up to 12 months (instead of 9 months) after the date the employee’s or member’s insurance under the policy would otherwise have terminated because of termination of employment or membership or reduction in hours below the minimum required by the group plan. Establishes notification requirements by the insurer and employer to the employee.
Status: Passed House, Senate Referred to Rules
HB 4940 Mautino - Amends the Illinois Insurance Code. Provides that a policy or plan that provides coverage for hospital or medical treatment on an expense incurred basis, may offer wellness coverage that allows for a reward, a health spending account contribution, a reduction in premiums or reduced medical, prescription drug or equipment copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement program approved or offered by the insurer or managed care plan.
Status: House 3rd Reading
HB 5192 Harris (Collins) - Amends the Illinois Public Aid Code, the Illinois Insurance Code, and other Acts. Provides that on and after July 1, 2008, screening and diagnostic mammography shall be reimbursed under the medical assistance program at the same rate as the Medicare program’s rates, including the increased reimbursement for digital mammography. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act must provide coverage for all medically necessary pain medication and pain therapy related to the treatment of breast cancer on the same terms and conditions that are generally applicable to coverage for other conditions. Provides that mandatory insurance coverage relating to mammography shall be provided at no cost to the insured and shall not be subject to an annual or lifetime maximum benefit.
Status: Passed House, Senate Referred to Rules
HB 5285 Jefferson (Hendon) - Amends the Illinois Insurance Code to require the continuation of coverage for a dependent college student who takes a medical leave of absence or reduces his or her course load to part-time status because of an illness or injury.
Status: Passed House, Senate 2nd Reading
HB 5595 Coulson (Crotty) - Amends the Illinois Insurance Code and the Health Maintenance Organization Act to provide coverage for habilitative services, including, but not limited to occupational therapy, physical therapy, and speech therapy for children under the age of 19 with congenital or genetic defects existing at or from birth or with a defect acquired at a young age. Amends the State Mandates Act to require implementation without reimbursement.
Status: Passed House, Senate Referred to Rules
HB 5865 Flowers (Crotty) Creates the Premium and Loss Data Reporting Act. Provides that all insurers subject to the Act shall report to the Director of the Division of Insurance accurate and complete information for each accident and health coverage type requested. Sets forth the specific types of accident and health coverage requested for reporting.
Status: Passed House, Senate Referred to Rules
SB 1900 DeLeo (Saviano) -Amends the Illinois Insurance Code to provide coverage for autism spectrum disorders to the extent that the diagnosis and treatment of autism spectrum disorders are not already covered by the policy or plan. Provides that this coverage shall be subject to a maximum benefit of $36,000 per year, but shall not be subject to any limits on the number of visits to an autism service provider. Makes other changes. Effective immediately.
Status: Passed Senate, House Referred to Rules
SB 2002 Haine (Mautino) Amends the State Employees Group Insurance Act of 1971. With respect to the participation of units of local government, school districts, rehabilitation facilities, and child advocacy centers in the group health insurance plan, permits participation with fewer than all employees enrolled as long as (i) those not enrolled are covered spouses or dependents in this or another plan or (ii) at least 50% of employees are enrolled (now, for units, districts, and facilities, at least 85% of employees must be enrolled and for child advocacy centers, all employees must be enrolled without exception). Effective immediately.
Status: Passed Senate, House Referred to Rules
SB 2486 Kotowski (Mathias) - Amends the Illinois Insurance Code. Provides that a policy or plan that provides coverage for hospital or medical treatment on an expense incurred basis, may offer wellness coverage that allows for a reward, a health spending account contribution, a reduction in premiums or reduced medical, prescription drug or equipment copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement program approved or offered by the insurer or managed care plan. Provides that “wellness coverage” means health care coverage with the primary purpose to engage and motivate the insured or enrollee through: incentives; provision of health education, counseling, and self-management skills; identification of modifiable health risks; and other activities to influence health behavior changes. Makes other changes. Effective January 1, 2009.
Status: Passed Senate, House Assigned to Healthcare Availability and Access
SB 2499 Crotty (Coulson) Provides for coverage for habilitative services for children under 19 years of age with a congenital, genetic, or early acquired disorder (was congenital or genetic defect existing at or from birth or a defect acquired at a young age); provides conditions for the coverage; makes changes in the definition of “habilitative services”; sets forth general exclusions and limitations of the coverage; and provides that upon request of the reimbursing insurer, the provider under whose supervision the habilitative services are being provided shall furnish medical records, clinical notes, or other necessary data to allow the insurer to substantiate that initial or continued medical treatment is medically necessary and that the patient’s condition is clinically improving.
Status: Passed Senate, House Referred to Rules